Project Description: The American Cancer Society (ACS), American Society for Colposcopy and Cervical Pathology (ASCCP), American Society for Clinical Pathology (ASCP), and the U.S. Preventive Services Task Force (USPSTF) have recently released revised guidelines for cervical cancer screening that downplay the role for annual cytology screening, long a mainstay of cervical cancer prevention. While the two sets of guidelines — one from a joint ACS/ASCCP/ASCP expert panel and the other from the USPSTF — differ in certain details, they are generally similar and likely to cause confusion and concern among women accustomed to older recommendations for more frequent screening. As always, the best course of management is for women, empowered with knowledge of the guidelines and well-informed of the their own test results, to engage in constructive dialog with their providers about individualized management. Factors such as age, results of recent screening tests, and medical history all enter into management decisions. The Pap App will provide a mobile (iOS) database for women to keep track of their test results and see what the guidelines recommend based on their individual results, while encouraging women to engage in dialog with their providers about the best approach.
Project Deliverable: The Pap App will be a FileMaker-based application that can be loaded onto an iPhone, iPod, or iPad. It will run on top of the free “FileMaker Go 12” iOS database app (available in the Apple App Store), into which it will simply be loaded as a file, via direct download through mobile Safari (hosting site TBD) or through iTunes. On first opening the Pap App, a woman will enter her date of birth and relevant medical history. A “read-me” screen will provide an overview of the app’s purpose, general information about HPV and cervical cancer, and a disclaimer that the Pap App is not a substitute for professional care provided by a qualified clinician, but rather is intended to help the patient understand how the current guidelines apply to her. After each visit at which a cervical cancer screening test (e.g., cytology or HPV testing) is performed, the woman will be able to enter her results and, with a tap, bring up a screen to see what the guidelines would recommend for follow-up testing intervals and approach. Wherever the two sets of guidelines differ, this will be indicated.
Impact: The Pap App will leverage UCSF’s long-standing role at the forefront of HPV and cervical cancer research and contribute toward the university’s mission to improve health care outcomes. While cytology screening has markedly reduced mortality from cervical cancer in the U.S. and elsewhere, changes in guidelines for cancer screening are often cause for confusion and stress, potentially leading to negotiation between patient and provider that results in overscreening or inappropriate management. By empowering women to understand how the new guidelines apply to their individual histories, it is hoped that the Pap App will contribute toward the guidelines’ goal of “maximiz[ing] protection against cervical cancer while minimizing the potential harms associated with false-positive results and overtreatment” (Saslow D, et al. Am J Clin Pathol 2012;137:516-42.).
Moyer VA. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012;156:880-91.
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol 2012;137:516-42.
• Mark Scott, MD, visionary, project coordination, and programming — will provide overall direction as well as database and user-interface design and programming. Dr. Scott is a FileMaker 12 Certified Developer and co-investigator on the “Natural History of HPV in Adolescents” study (NCI).
• Anna-Barbara Moscicki, MD, subject matter expert — will provide expert consultation regarding the guidelines and algorithms, as well as critical feedback on the overall app design. Dr. Moscicki co-chaired the “Impact of HPV vaccination on future screening practices” working group of the ACS/ASCCP/ASCP expert panel and is principal investigator on the “Natural History of HPV in Adolescents” study.
• Janet Jonte, NP, content creation — will provide consultation, from a provider’s perspective, regarding expression of the guidelines in patient-centric terms as well as critical feedback on the overall app design. Ms. Jonte has extensive experience providing gynecologic care to adolescent and adult populations and has examined and counseled patients in the “Natural History of HPV in Adolescents” study for the past 13 years.
Estimated Time Commitments:
Mark Scott: 115 hours (35 hrs departmental and 80 hrs independent, see attached letter of pre-approval)
Anna-Barbara Moscicki: 30 hours
Janet Jonte: 10 hours (departmental, see attached letter of pre-approval)
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