Cervical Cancer Screening: Are We Doing it “Righteously”?
Sondos Al Sad, MD, MPH, NCMP, Assistant Professor - Clinical, The Ohio State University
Background
A growing number of studies are exploring the difficulties performing pap smears on Muslim women. Such studies often highlight modesty and lack of reproductive health discussions as obstacles which healthcare providers shall navigate to adequately provide preventive screenings and needed therapies. Considering the efforts being made to encourage the mentioned population to undergo cervical cancer screenings, a few questions arise. First, what are the chances of cervical cancer occurring in virgin females? or in sexually inactive females who have previously had normal pap smears? What risk percentage - coupled with a yet unknown combination of risk factors - should prompt a healthcare provider to conduct a cervical screening on a virgin woman? Is it likely that our limited understanding of how culture and religion impact the lifestyles and consequent health trends in Muslim populations maybe the overlooked variable in implementing preventive screenings.
Objective
To re-evaluate the current cervical cancer screening recommendations addressing virgin and low risk Muslim Women.
Methods
PubMed and Ohio State University (OSU) online libraries search was conducted for English language, North America-based articles published between 2000 and 2019 using cervical cancer screening, routine pelvic examination, virgin patients, modesty, minorities, Muslim women, sexually inactive women and screening guidelines as keywords to find supporting evidence to current cervical cancer screening guidelines in virgin and Muslim women.
Results
Despite extensive review of relevant articles and guidelines for cervical cancer screening, the statement on factoring in virginity in the clinical guidelines is obsolete.
Discussion Routine pelvic examination for cervical cancer screening has proven its success through significant decrease in cancer prevention and cancer-related mortality. Since the 1980’s up until 2002, various US clinical societies recommended cervical screenings with the onset of sexual activity regardless of the female's age. In 2003, revised guidelines were issued by involved societies to address the harms caused by false positive findings and subsequent invasive modalities of management. However, the current guidelines do not explicitly address special populations such as females who have never been sexually active, or Muslim women who practice modesty in sexual interactions. Researching cervical cancer screening incidence in virgin patients yielded mostly case reports implying the rarity of its occurrence.
Conclusion
Current guidelines of cervical cancer screening through routine pelvic examination lack supportive evidence in virgin Muslim patients, which may require further studies to identify risks versus benefits in Muslim virgin female patients. More explicit recommendations regarding sexual activity role in routine pelvic examination are needed rather than considering religious modesty as a barrier to cancer prevention practices.
A growing number of studies are exploring the difficulties performing pap smears on Muslim women. Such studies often highlight modesty and lack of reproductive health discussions as obstacles which healthcare providers shall navigate to adequately provide preventive screenings and needed therapies. Considering the efforts being made to encourage the mentioned population to undergo cervical cancer screenings, a few questions arise. First, what are the chances of cervical cancer occurring in virgin females? or in sexually inactive females who have previously had normal pap smears? What risk percentage - coupled with a yet unknown combination of risk factors - should prompt a healthcare provider to conduct a cervical screening on a virgin woman? Is it likely that our limited understanding of how culture and religion impact the lifestyles and consequent health trends in Muslim populations maybe the overlooked variable in implementing preventive screenings.
Objective
To re-evaluate the current cervical cancer screening recommendations addressing virgin and low risk Muslim Women.
Methods
PubMed and Ohio State University (OSU) online libraries search was conducted for English language, North America-based articles published between 2000 and 2019 using cervical cancer screening, routine pelvic examination, virgin patients, modesty, minorities, Muslim women, sexually inactive women and screening guidelines as keywords to find supporting evidence to current cervical cancer screening guidelines in virgin and Muslim women.
Results
Despite extensive review of relevant articles and guidelines for cervical cancer screening, the statement on factoring in virginity in the clinical guidelines is obsolete.
Discussion Routine pelvic examination for cervical cancer screening has proven its success through significant decrease in cancer prevention and cancer-related mortality. Since the 1980’s up until 2002, various US clinical societies recommended cervical screenings with the onset of sexual activity regardless of the female's age. In 2003, revised guidelines were issued by involved societies to address the harms caused by false positive findings and subsequent invasive modalities of management. However, the current guidelines do not explicitly address special populations such as females who have never been sexually active, or Muslim women who practice modesty in sexual interactions. Researching cervical cancer screening incidence in virgin patients yielded mostly case reports implying the rarity of its occurrence.
Conclusion
Current guidelines of cervical cancer screening through routine pelvic examination lack supportive evidence in virgin Muslim patients, which may require further studies to identify risks versus benefits in Muslim virgin female patients. More explicit recommendations regarding sexual activity role in routine pelvic examination are needed rather than considering religious modesty as a barrier to cancer prevention practices.