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Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.  

CH Discussion:

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Discuss any “take-away” thoughts from the article.
This article provided information on prophylactic hysterectomy for patients who have a
history of first-degree and second-degree relative of ovarian cancer, and associated malignancies
that increased their risk of acquiring this type of cancer. According to the statistics and data
obtained from this study a prophylactic hysterectomy should not be utilized to prevent ovarian
cancer. The proper intervention instead is benign gynecologicalscreening for those who have a family history of endometrial cancer especially the Ashkenazi
Jewish ethnicity background. Although the study concluded that a prophylactic hysterectomy is
inconclusive, there are instances when the benefits outweigh the risks.
What are the ethical dilemmas to consider with prophylactic surgeries?
Ethical dilemmas are the greatest challenges the provider will face if elective
prophylactic surgery is chosen by the patient. Excellent communication between the patient and
the interdisciplinary healthcare team is important. Assessment of the patient’s learning style, and
knowledge of learning barriers is essential. Proper education of the pros and cons of prophylactic
surgery will give the patient the option of whether to proceed with the procedure or withdraw.
Physiological as well as, psychological implications are the determining factor for prophylactic
surgeries (Jain & Somalwar, 2019).  For example, women who chose to have bilateral prophylactic salpingo-oophorectomy
will experience severe vasomotor effects and require hormone replacement therapy to alleviate
the symptoms of menopause. Another dilemma the female patient will face if she is at a reproductive age, is losing the ability to become pregnant. Considerations for the proper approach to prophylactic surgeries should include a benefit versus risk (NIH, 2018).
Discuss the screenings/interventions/options/education that you would provide to a patient.
Screening for ovarian cancer is not currently recommended for the average patient. The
screening method available today is the serum is the CA 125 is a marker that is produced by the
cancer cells. The CA 125 levels will be elevated in women who have ovarian cancer. The test
results can also produce a false-positive or false negative. There is no accurate and reliable
testing available and research is still ongoing. If the patient is at high risk for ovarian cancer and
has a first degree relative with ovarian cancer, the provider must include: genetic counseling,
ultrasound exam of the ovaries for women who carry BRCA1 and BRCA2 mutations. Other
interventions include cervical screening for women ages 21 through 65 because of the potential
exposure to human papilloma virus through sexual contact and a pelvic exam to determine if
abnormalities are present (AGOC, 2018). Education must be stressed with the importance of
health maintenance screening. Factors that will increase the patient’s risk for ovarian cancer are
obesity, having children late in life, use of fertility treatment to become pregnant, and hormone
replacement therapy (American Cancer Society, 2018).
What if the patient has no health insurance? What resources could you offer to assist the
patient?
Healthcare resources depends on the patient’s employment status. Medicaid is available
to those who meet the income guidelines. If the patient does not have medical insurance, I would
refer her to the social worker. There are resources available to those who are uninsured and are unable to afford healthcare services.
(United States Department of Labor, 2018).
References
American Cancer Society. (2018) Ovarian Cancer Risk Factors. Retrieved from
https://www.cancer.org/cancer/ovarian-cancer/causes-risks-prevention/risk-factors.htmlJain, S. & Somalwar, S. (2019).  Analysis of prophylactic saplingo-oophorectomy at the time of hysterectomy for benign lesions.  Journal of Midlife Health 10(1).  doi: 10.4103/jmh.JMH_70_18
National Cancer Institute (NIH). (2018). Surgery to reduce the risk of breast cancer. Retrieved
from https://www.cancer.gov/types/breast/risk-reducing-surgery-fact-sheet#q5
The American College of Obstetricians and Gynecologists (AGOC). (2018). BRCA-1 and
BRCA-2 Mutations. Retrieved from https://www.acog.org/Patients/FAQs/BRCA1-andBRCA2-Mutations?IsMobileSet=false#ovarian 

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