Clinical meaning
The NP applies evidence-based screening guidelines across the lifespan for cervical, breast, prenatal, and STI diagnostics. Cervical cancer screening follows ASCCP/USPSTF guidelines: Pap smear alone every 3 years for ages 21-29, or co-testing (Pap plus HPV) every 5 years for ages 30-65. Abnormal results are triaged per ASCCP risk-based management consensus guidelines -- ASCUS with positive high-risk HPV warrants colposcopy, while ASCUS with negative HPV can return to routine screening. LSIL in patients aged 25 and older requires colposcopy; HSIL requires expedited colposcopy or immediate loop electrosurgical excision procedure (LEEP). Mammography screening per USPSTF recommends biennial screening mammography for average-risk women aged 40-74. The NP identifies patients meeting criteria for BRCA genetic testing: Ashkenazi Jewish ancestry, personal history of breast cancer before age 50, triple-negative breast cancer before age 60, two or more primary breast cancers, male breast cancer in the family, or known BRCA mutation in a family member. Prenatal screening includes first-trimester combined screening (nuchal translucency ultrasound plus serum PAPP-A and free beta-hCG at 11-14 weeks), quad screen (AFP, hCG, estriol, inhibin A at 15-22 weeks), and cell-free DNA/NIPT (available from 10 weeks, with greater than 99% sensitivity for trisomy 21). STI screening follows CDC guidelines: annual chlamydia and gonorrhea screening for sexually active women under 25 and those with risk factors, HIV screening at least once for all patients aged 15-65, hepatitis B screening in pregnancy, and syphilis screening in pregnancy and high-risk populations. HPV vaccination is recommended through age 26 (catch-up through age 45 via shared clinical decision-making).