CHAPTER 4: SCREENING FOR CERVICAL CANCER

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118PS 8: Taking a Pap SmearPS 8PS 8: Taking a Pap Smear12. If you saw something for which you wish to refer the woman to a higher level,explain why, where and when she must go, and whom to see; stress theimportance of keeping this appointment.13. Suggest to the woman that she encourage family members and friends in thetarget age group to come in for a Pap smear.Follow-up14. When the woman returns, give her the test results, explain what they mean, andadvise what needs to be done.• If the test is negative (normal), tell her to have another test within 3 years (oras per national guidelines).• In the other cases, use the flowchart in Annex 4a to advise the woman onhow she should be followed up.Annex4aFlowchart PAP15. If the woman does not return, and her smear was abnormal orinadequate, try to contact her. A sample letter to send to suchpatients is given in Annex 7. Other strategies to ensure return aredescribed in Chapter 4.Annex 7DocumentsYour task is not completed until each woman has been told her test results,or at least those women with abnormal test results.
PS 9: Collecting Samples for HPV DNA Testing 119PRACTICE SHEET 9: COLLECTING SAMPLES <strong>FOR</strong> HPV DNATESTINGPS 9For HPV DNA testing, secretions are collected from the cervix or vagina using a swabor small brush, and placed in a special liquid to be sent to the laboratory. There theycan be tested for HPV infection, which can stimulate changes in the cells covering thecervix. The test does not diagnose cervical precancer or cancer.The following materials and supplies are needed to collect samples for HPV testing:• soap and water for washing hands;• a light source to examine the cervix;• an examination table covered by clean paper or cloth;• a speculum, high-level disinfected (it need not be sterile);• disposable or high-level disinfected examination gloves;• small brush or soft swab;• small container with preservative solution;• recording form;• small container of warm water to lubricate and warm the speculum;• 0.5% chlorine solution for decontaminating instruments and gloves.Practice Sheet 9: Collecting Samples for HPV DNA TestingTAKING A SAMPLE <strong>FOR</strong> HPV TESTINGNote the following:• It is best not to take a sample from women who are actively menstruating. Slightbleeding is acceptable.• HPV testing, if available, is most useful when done in conjunction with acytological test, in women aged 35 years or older.Use Practice Sheet 4 to give counselling before doing any examination,test or procedure. Counselling steps specific to the HPV test are includedin the steps below.PS4Counselling
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CHAPTER 4: SCREENING FOR CERVICAL CANCER

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