Adult Immunization

Anaphylaxis

Food Allergies

Seasonal Allergies

Allergy

Atrial Fibrillation

Heart Failure

Hypertension

Lipid disorders

Cardiology

Clinical Technology

Atopic Dermatitis

Psoriasis

Rosacea

Dermatology

Adrenal Disorders

Diabetes

Thyroid Disorders 

Endocrinology 

C Difficile Infection

Celiac disease

GERD

Inflammatory Bowel Disease

Irritable Bowel Syndrome 

Gastroenterology

Hepatitis

MASLD/MASH

Hepatology

Coronavirus

HIV AIDS

Hepatitis C

Influenza

Pneumonia

Sexually transmitted infections

Infectious Disease

Chronic Kidney Disease

Nephrology

Alzheimer Disease/Dementia

Cerebrovascular Diseases

Epilepsy

Headache

Mental Health

Migraine

Parkinson Disease

Sleep Disorders

Neurology

Obesity Medicine

Fibromyalgia

Pain Management

Pediatric Immunization

Pediatrics

ADHD

Anxiety

Depression

Eating Disorders

PTSD

Panic Disorder  

Psychosis

Substance-related Disorders

Psychiatry 

Asthma

COPD

Cystic Fibrosis

Interstitial lung disease

Pulmonary hypertension

Pulmonology

Gout

Lupus

Osteoarthritis

Psoriatic arthritis

Rheumatoid Arthritis

Rheumatology

Breast Cancer

Cervical Cancer

Colorectal Cancer

Lung Cancer

Melanoma

Prostate Cancer

Renal Cancer

Skin cancer

Screening

Menopause

Osteoporosis

Pregnancy and Birth

Women's Health

News

All News

Editorial Podcasts

Practice Management

Video Interviews

Media

Around the Practice

Between the Lines

ConsultantLive

Frontline Insights

Institutional Insights

Primary View

Provider Toolkits

Screening Series

Conferences

Conference Coverage

Conference Listing

Product Theater Recaps

Resources

Interactive Posters

Product Profile

Publications

Subscribe

CE/CME

Patient Care Online offers clinical news and resources for primary care clinicians, focusing on disease states, guidelines, and trends to improve care.

About Us

Advertise

Contact Us

Editorial Board

Terms and Conditions

Privacy

Do Not Sell My Information

Patient Care Online – Primary Care News and Clinical Resources

Facebook

LinkedIn

Clinical Focus

Allergy & Immunology

Endocrinology

Men’s Health

Psychiatry

Women’s Health

Business Focus

Billing and Collections

Career Planning

Coding and Documentation

Concierge Medicine

Cybersecurity

EHRs

Investing

Patient Relations

Personal Finance

Remote Patient Monitoring

Staffing

Technology

Telehealth

Value-based Care

Spotlight

VMS and Menopause

Atopic Dermatitis Provider Toolkit

Adult Immunization Provider Toolkit

Dermatology Hot Topics

1rem

Authors

Topical steroids and antifungals have not only failed to resolve the bilateral rash; the teen says they’ve made it worse. Your Dx?  

Underarm Eruption in a Teenaged Boy

How to Address Patient Hesitancy Around Cervical Cancer Screening with Ada Stewart, MD

Patient hesitancy remains a barrier to timely 

 screening, even when guidelines are clearly communicated. Anxiety around Pap smears—including discomfort with the exam and fear of results—can discourage women from keeping up with recommended screening schedules. Primary care physicians are in a unique position to address these concerns directly during routine visits, ensuring patients are informed, supported, and comfortable throughout the process.

, Ada Stewart, MD, a board-certified family physician, discusses practical strategies clinicians can use to reduce patient anxiety during screening exams. From incorporating shared decision-making to simple in-office adjustments such as using a smaller speculum, playing background music, or offering staff support, Dr Stewart highlights ways to make cervical cancer screening a more patient-centered experience.

The following transcript has been lightly edited for style and flow.

 Yes. It’s really important that, as a primary care clinician and family physician, I inform my patients and make sure that all decisions are shared between myself and them. I talk about the guidelines, the recommendations, and the limitations of the tests we perform. I also make sure to assess their comfort level with the Pap smear and address any concerns.

If it’s about pain with the speculum exam, I try to use the smallest available speculum. Sometimes I’ll have music playing in the background. I may even have one of my staff hold the patient’s hand. It’s all about shared decision-making—making sure the patient is well informed about what the guidelines say, what’s best for them, and what limitations may occur—while ensuring they are comfortable with the exam itself.

Ada Stewart, MD, shares strategies for primary care physicians to reduce patient anxiety and improve comfort during cervical cancer screening exams.

Clinical Topics

How to Address Patient Hesitancy Around Cervical Cancer Screening With Ada Stewart, MD

Exact Sciences has announced the launch of Cancerguard™, a multi-cancer early detection (MCED) blood test now available as a laboratory-developed test in the United States. According to the company’s September 10, 2025, announcement, Cancerguard is the first commercially available MCED test to analyze multiple biomarker classes, designed to expand early cancer detection beyond currently recommended screening tests.

Most cancers in the US are diagnosed at advanced stages, and nearly 70% of cancer cases and deaths occur in malignancies without existing screening options.

 Cancerguard aims to complement current population-based screening by detecting cancers responsible for more than 80% of annual diagnoses, including pancreatic, ovarian, liver, esophageal, lung, and stomach cancers. In development studies, the test demonstrated sensitivity of 68% across six of the deadliest cancers, 64% overall sensitivity across a broader group (excluding breast and prostate), and 97.4% specificity. Notably, it identified over one-third of stage I and II cancers, where treatment options are most effective.

Modeling studies project that use of MCED technology alongside current screening could reduce stage IV cancer diagnoses by 42% and overall cancer mortality by 18% over 10 years. Cancerguard is priced at $689 and will be available nationwide through Quest Diagnostics’ approximately 7000 patient access sites, with additional in-office and at-home phlebotomy options.

The test is supported by nearly a decade of development and validation in collaboration with academic partners. Key studies include DETECT-A and ASCEND-2, involving more than 20 000 participants, including the first prospective interventional MCED trial. Exact Sciences is also conducting the Falcon registry, enrolling up to 25 000 participants under a US FDA-reviewed Investigational Device Exemption to evaluate real-world utility and support regulatory submissions.

Cancerguard is intended for adults aged 50–84 years without a known cancer diagnosis in the past 3 years and can be ordered annually. Results integrate into electronic medical records and are supported by care navigation services for both clinicians and patients. For individuals with positive test results, Exact Sciences provides imaging assistance programs to reduce the cost of follow-up diagnostics not covered by insurance.

Kevin Conroy, chairman and CEO of Exact Sciences, stated that Cancerguard “represents the next bold step in our mission to detect cancer earlier.” Tom Beer, MD, chief medical officer for multi-cancer early detection at Exact Sciences, added that the test “offers a critical early warning that cancer may be present and helps inform an imaging-guided pathway to diagnosis.”

Exact Sciences. Exact Sciences launches Cancerguard™, first-of-its-kind multi-cancer early detection blood test. News release. September 10, 2025. Accessed September 10, 2025. 

https://www.exactsciences.com/news-events/press-releases/exact-sciences-launches-cancerguard-first-of-its-kind-multi-cancer-early-detection-blood-test

Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025.

United States Preventive Services Task Force. A and B recommendations. Published 2022. Accessed September 10, 2025. 

https://uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations

Exact Sciences launches Cancerguard, a groundbreaking blood test for early cancer detection, aiming to transform cancer screening and save lives.

New Cancerguard Blood Test for Multicancer Early Detection Now Available in the US

According to the World Health Organization, vaccination saves approximately 4 to 5 million lives annually, a number supported by estimates published in the Lancet in 2024 that vaccination against 14 different diseases saved 154 million lives over the past 5 decades. Among those saved were 146 million children younger than age 5 years and of that group 101 million were infants younger than 1 year. Beyond the prevention of death, authors of the 2024 study found that every life saved through immunization translated to an average of 66 years of full health.

While vaccination coverage for core immunizations among both children and adults in the United States remains high overall, recent CDC surveillance highlights notable disparities in uptake between states and population subgroups. Gaps in insurance coverage, logistical challenges, and misinformation are persistent barriers, continuing to impact communities unevenly and contributing to lower coverage rates in some regions and among specific demographic groups. 

A recent study conducted by WalletHub examined the 50 states and the District of Columbia across 16 key metrics to see where Americans appear to be most responsible about getting vaccines. The data set ranges from the rates of children, teens and adults vaccinated against various diseases to the share of people without health insurance.

The findings presented in this PPT provide timely insights into these disparities and influencing factors by comparing states on three key dimensions: 1) Children & Teenagers Immunization Rates, 2) Adult & Elderly Vaccination Rates, and 3) Immunization Uptake Disparities & Influencing Factors. The data can inform clinicians, educators, and policymakers seeking to direct resources, strengthen outreach, and promote equitable protection against preventable illness.

According to the World Health Organization, vaccination saves approximately 4 to 5 million lives annually,

 a number supported by estimates published in the 

 in 2024 that vaccination against 14 different diseases saved 154 million lives over the past 5 decades. Among those saved were 146 million children younger than age 5 years and of that group 101 million were infants younger than 1 year. Beyond the prevention of death, authors of the 2024 study found that every life saved through immunization translated to an average of 66 years of full health.

Northeastern states consistently ranked highest on measures including rates of flu vaccination across age groups, number of teens vaccinated against HPV, and older individuals with shingles vaccination. 

9 States Ranked Highest for Population Vaccination 

Use of vaginal estradiol tablets was not associated with an increased risk of recurrent ischemic stroke among women with a prior ischemic stroke, according to findings from a nationwide nested case-control study published in 

“It is well known that taking systemic hormone replacement therapy, such as oral estrogen tablets, may increase the risk of stroke after menopause. While other studies have not detected an increased risk of stroke associated with the use of vaginal estrogen in healthy postmenopausal women, there is no data on whether vaginal estrogen tablets pose an increased risk for women who have already had a stroke,” lead author Kimia Ghias Haddadan, MD, affiliated with the department of cardiology at Copenhagen University Hospital – Herlev and Gentofte in Copenhagen, Denmark, said in a press release.

Researchers from Copenhagen University Hospital analyzed data from 34 274 women aged 45 years and older who experienced a first ischemic stroke in Denmark between 2008 and 2017. Among these, 3353 cases of recurrent stroke were identified and matched by birth year to 3353 controls. The median age was 75 years.

When adjusted for comorbidities, medications, income, and education, vaginal estradiol exposure was not associated with an increased rate of recurrent ischemic stroke. The adjusted hazard ratio (aHR) for current use (within 0–3 months before the index date) was 0.79 (95% CI, 0.52–1.20; 

 = .27). For recent use (3–24 months before the index date), the aHR was 1.09 (95% CI, 0.73–1.63; 

 = .67), and for past use (>24 months before the index date), the aHR was 1.48 (95% CI, 0.95–2.30; 

 = .08). Results did not differ by dose or cumulative exposure.

The investigators noted that systemic hormone replacement therapy has been linked to an increased risk of ischemic stroke in postmenopausal women, and guidelines generally contraindicate its use in women with prior stroke. Vaginal estrogen, however, is often prescribed as first-line therapy for genitourinary syndrome of menopause, a condition affecting up to 70% of postmenopausal women. Because vaginal estrogen products are absorbed systemically and can mildly raise plasma estradiol levels, the study sought to clarify whether these changes influence stroke recurrence risk.

The study found no evidence of increased risk associated with vaginal estradiol use, providing reassurance for clinicians treating genitourinary syndrome of menopause in women with a history of stroke. “Based on our findings, vaginal estradiol tablets are not likely to increase the risk of recurrent ischemic stroke in women with prior stroke,” authors concluded.

Limitations included the observational design, potential residual confounding, and reliance on prescription records rather than confirmed medication use. Data were limited to vaginal estradiol tablets, the most common formulation in Denmark, and findings may not generalize to other forms of vaginal estrogen therapy.

Haddadan KG, Eckert-Lind C, Meaidi A, et al. Recurrent ischemic stroke and vaginal estradiol in women with prior ischemic stroke: A nationwide nested case-control study. 

Published online August 21, 2025. doi:10.1161/STROKEAHA.125.050986

Vaginal estrogen tablets may be safe for postmenopausal women who have had a stroke. News release. American Heart Association. August 21, 2025. Accessed August 21, 2025. 

https://newsroom.heart.org/news/vaginal-estrogen-tablets-may-be-safe-for-postmenopausal-women-who-have-had-a-stroke

Vaginal estradiol is often prescribed as first-line therapy for genitourinary syndrome of menopause, making the findings supportive of current clinical practice. 

Martin Reichel, MD

Articles

Latest Updated Articles