Cervical cancer has become the main cause of deaths for women in the 21 st century. The disease could have multiple causes but earlier diagnosis and treatment could save many lives. The screening program is associated with ethical, cultural and socioeconomic challenges (Aniebue & Onyeka, 2014). The challenges hinder women from going for Pap smear tests leading to increased risk of succumbing to cervical cancer when the symptoms become full blown (Barboza & Arbona, 2018). The paper highlights some of the ethical considerations and problems that arise when providing cervical cancer screening programs.
Evidence-based practice
Cervical cancer screening is done via a series of tests that target to give actual results. First, testing can be done using visual inspection with acetic acid (VIA). However, this method may not give actual results hence more appropriate methods like human papillomavirus (HPV) Deoxyribonucleic Acid (DNA) testing is used to prove or correct the visual method. It is believed that a single visit for VIA testing can minimize the danger of developing cervical cancer by 26 percent while the testing of human papillomavirus (HPV) reduces the risk by 37 percent. Gyawali et al., (2015) explained that women who go for a single visit are screened and treated but for a two-visit, a patient is expected to go back for the results and necessary treatment. Women who are at their late thirties and early forties are predicted to save their lives from cancer risk by 65 percent through visual inspection with acetic acid (VIA) testing while human papillomavirus (HPV) Deoxyribonucleic Acid (DNA) testing drastically reduces infection by 76 percent. Different screening methods depend on existing test characteristics.
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Some reports concluded that the use of human papillomavirus (HPV) testing and cytology is unreasonable and cannot be sustained due to the time frame needed to acquire the evidence. Therefore, more evidence is needed to arrive at the optimal approach that would be more realistic and accurate (Modibbo et al., 2016). High costs associated with the use of human papillomavirus (HPV) testing have also been criticized. Further reports showed that quality issues used in pharmacological trials are not important in large trials. More follow-ups are needed for patients who have experienced a complete response to treatment. The reason for follow-ups focus on determining survival means, recurrence detected during the screening and the overall quality of life (Hammer, 2016). The clinician involved in the care and follow-up of patients undergoing treatment for cervical cancer is supposed to promote evidence-based clinical practice.
The risks and challenges associated with screening
Screening for cervical cancer has its shortcomings. First visual inspection with acetic acid (VIA) screening has been reported to give false-positive results where patients who have no disease are taken as a high potential risk of contracting the disease (Tao, 2017). Women undergo follow up testing that may not be comfortable due to high costs, stigma associated, and even potentially harmful due to unnecessary treatments. Patients may suffer from psychological distress and anxiety. Another risk of screening is giving false negative results where patients are tested wrongly as having no infection but in reality, are infected with the disease (Mokhele et al., 2016). The patient is usually at risk of succumbing to the disease since the false assurance makes them feel safe and far from any infection.
The psychological impact of screening revolves on fear, shame, and blame that may make women believe that they would be abandoned by their families and spouses. It may lead to divorce when blame game comes into play as one partner accuse another of having extramarital affairs (Soumita & Bhattacharya, 2019). There is a lack of response and low coverage when patients are invited for free screening thus becoming an obstacle to earlier detection and diagnosis of cervical cancer. The government fails to compensate hospitals that conduct screening since free tests do not cover the full cost of the programs like treatment which is expensive for the patients. There is a shortage of competent healthcare personnel who understands screening tests which is a significant barrier to quality cervical cancer screening services (Singer & Khan, 2018). Low health awareness and knowledge of cervical cancer screening among rural women also increase the risk of developing the disease to untreatable stages.
HIPAA/ FERPA concerns
Health Insurance Portability and Accountability Act (HIPAA) body is charged with the mandate of securing and maintaining the privacy of patient data and information against access by unauthorized persons (Scott, 2017). The body was established due to continuous data breach of patient health information caused by cybercrime attacks on health providers and health insurance companies. Health Insurance Portability and Accountability Act (HIPPA) focuses on protecting patient health information, securing electronic records, simplifying administrative procedures and ensuring portability of insurance services (Aniebue & Onyeka, 2014). The privacy rules establish national standards that focus on protecting any medical information against a breach. The rules also focus on establishing good healthcare plans that transact healthcare information and data electronically (Gyawali et al., 2015). Therefore, acquisition, access or disclosure of health information is an illegality that compromises security and privacy of medical information which amounts to a breach of Health Insurance Portability and Accountability Act (HIPAA) privacy rule.
Ensuring Informed Consent
All patients are entitled to making decisions regarding their health while the healthcare providers are under the obligation to provide health information as per the requirement of informed consent to the patient. The attending physician is bound to respect the patient decision of unnecessary treatment since it is ethically and legally permissible. Castanon et al., (2014) asserted that informed consent requires a healthcare provider to give information concerning a patient’s risk of contracting cervical cancer after the necessary test have been done. Additionally, the doctor involved in screening should state the benefits of screening, accuracy of the test, and treatment procedures involved if a positive result is detected after screening (Scott, 2017). Proper communication to the patient and family would promote acceptance and uptake visual inspection with acetic acid (VIA) screening.
Conclusion
After screening, the follow up on the patients’ treatment is carried out by an experienced physician on the post-screening assessment of cancer patients. Patients are expected to make regular follow-ups after every two to five years depending on the age group. Hammer (2016) avers that the visits include assessment of patient medical history with a complete physical examination that should abide by medical ethics as laid down by Belmont report. The principles are based on the ethical conduct of research that involves human subjects. The report first recommended respect for persons involved as patients by treating them with dignity and allowing informed consent (Soumita et al., 2019). The second recommendation was beneficence which targets to reduce any possibility of causing harm and maximizes the benefit of research while lowering the risk associated with it. Finally, the last principle ensures that health providers do justice to all potential research participants by promoting reasonable and well-considered procedures.
References
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Mokhele, I., Evans, D., Schnippel, K., Swarts, A., Smith, J. S., & Firnhaber, C. (2016). Awareness, perceived risk, and practices related to cervical cancer and pap smear screening: a cross-sectional study among HIV-positive women attending an urban HIV clinic in Johannesburg, South Africa. South African Medical Journal , 106 (12), 1247-1253.
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Singer, A., & Khan, A. (2018). Cervical cancer screening. Cancer Prevention and Screening , 81-100. DOI:10.1002/9781118990957.ch8
Tao, J. (2017). High Incidence and Mortality of Cervical Cancer in the Southern United States. Epidemiology International Journal, 1 (1). Doi: 10.23880/eij-16000101
