Each clinic does Women’s Health Care as able, including PAP smears, breast exams, IUD Implanon placements/removal, and endometrial biopsies. There are several case managers who help with women’s health (see attached list). YKHC has a CDC Breast and Cervical Health Grant that helps YK bring in patients for PAP smears, annual exams and cancer diagnosis of breast or cervical or uterine cancer. The grant will pay for travel, meals and lodging if necessary for any women between the ages of 21-64.
The current YKHC PAP guideline suggests no PAP under 21 and then Q 3 years after that until 30. At 30 years – 65 years of age they need paps Q 5 years—as long as there is no hx of abnormalities.
We now use liquid PAPs (see LAB section). If abnormal PAPs, they are followed on a database by the CDC Breast and Cervical Care Manager: Nina Jones RN. We follow the ASCCP guidelines for dealing with abnormal PAPs. There is a great app for it on your smart phone.
Any abnormal looking cervixes, endometrial biopsies and skin lesion removals in the perineum that you feel need further work up, can be referred to Women’s Health in Bethel. Feel free to contact the Gynecology Case Manager for that @ 543-6557. Mammograms can begin at age 40 but, our current YKHC guideline is to start at age 45 and do them every 2 years.
For annual exams, you can use Well Woman’s encounter pathway note. Please make sure to document Family History, Procedure History and give Birth Control (Contraception - Quick Start YKHC Clinical Guideline).
If you have a patient with an abnormal breast exam she will need a mammogram and a breast ultrasound, both must be done prior to the surgeon seeing them. You need to clearly document where the mass is. If she is under 40 they will only do a sono. If she is over 40 they will do both a sono/mammo. (Breast Cancer Screening YKHC Clinical Guideline)
All referrals to ANMC surgery, whether to see the general surgeon in Bethel, in Specialty Clinic and/or a surgeon in Anchorage, need to have a phone consult with an ANMC surgeon and be documented on the specialty referral form. The WH Grant Case Manager (543-6296) will make sure that copies of the mammogram and sono go to ANMC for review prior to the patient’s visit.
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