Reference Manual - IARC Screening Group

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Tests for Cervical Cancer <strong>Screening</strong>VIADEFINITION/MECHANISM OFACTIONPROCEDURE BENEFITS LIMITATIONSVisual examination of theexocervix and SCJ usingthe naked eye(unmagnified) and aceticacidUsed solely as a screeningtestProcedure is described towoman• Reason• Procedure (what toexpect)• FollowupInsert the speculumMeets criteria of a goodscreening testMultiple assessments ofsensitivity and specificityindicate it is comparableto Pap smear and HPV orcolposcopyFew published studiesdocumenting the value asa screening test in widescaleuseFalse positives mayoverload the referralsystemResults reported as:• Test-positive• Test-negative• Suspicious for Cancer(See Chapter 6 for details)View the cervixWash the cervix with a3–5% acetic acid solutionInspect the cervixincluding the SCJ withthe naked eyePotential for single visitapproachRequires no equipment/maintenance other thansupply of acetic acid(vinegar), speculum andlight source (torch)Requires competencybasedtraining in order toinspect and makeassessmentCan be performed at anylevel of the healthcaresystem, by a mid-levelprovider with propertrainingVIAMVisual examination of thecervix using acetic acidand low-powermagnificationMay be accompanied bybiopsy of abnormalappearingtissueResults reported as:• Normal• Abnormal• Suspicious for CancerProcedure is described towoman• Reason• Procedure (what toexpect)• FollowupInsert the speculumView the cervixWash the cervix with a3–5% acetic acid solutionMeets criteria of a goodscreening testFew published studiesconcerning value ofscreening test, butavailable results so farindicate that the test doesnot appear to offer anyadvantage over VIAPotential for single visitapproachDependent on possessionof magnifying deviceInstrument may break,producing “rate-limitingstep,” potential for systembreakdownRequires moderatetraining for useUse a magnifying devicelike a monocle or opticalscope (2–4 power), tolook at the cervixInspect SCJ to identifyabnormal areasA-6 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Tests for Cervical Cancer <strong>Screening</strong>DEFINITION/MECHANISM OFACTIONThin-Layer Pap SmearPreparation(ThinPrep)PROCEDURE BENEFITS LIMITATIONSSpecimen preparationtechnique in which cellsare collected from cervix,suspended in a specialsolution, then plated in asingle, thin layer on aslide.Cytotechnician/pathologistthen examines the slide forcellular changes indicativeof inflammation, dysplasiaor cancerUsed as primary screeningmethodResults usually reportedas:• Normal• Inflammation• Atypical Cells ofUncertain Significance(ASCUS)• LGSIL• HGSIL• CancerProcedure is described towoman• Reason for test• Procedure (what toexpect)• FollowupInsert the speculumView the cervixUse a brush to “scrape”cells from the cervix andsmear them on a glassslideOnce specimen iscollected, the brush isplaced in a jar/containerwith a special medium;brush is swished aroundto create a suspension.Jar/container then sent tolab where specimen isplated onto slides, thenstained and read bytechnician/pathologistMeets some of the criteriaof a good screening test• Noninvasive• Treatment exists• Sensitive/specificAccording tomanufacturer and otherpublished studies,sensitivity and specificityare acceptable toclinicians andpolicymakersPermanent recordavailable in form of slideMedium (solution inwhich cells are placed)may also be used to testfor HPVRequires elaborate,complex infrastructure• Materials (slides,brushes, jars)• Reagent (transportmedium)• Facility whereThinPrepmethodology ispossible• Microscopes• Trainedcytotechnicians/pathologists• Reliable transport ofjars to site whereslides are preparedand read• ExpensiveIf any of thesecomponents are missing:• Small-scale programswill haveproportionatelygreater costs• Potential for systembreakdown• Jars easily broken ormay leak• See and treat notpossibleCervical Cancer Prevention Guidelines for Low-Resource Settings A-7
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Cervical Cancer PreventionGuideline
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TABLE OF CONTENTSPREFACE AND ACKNOW
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How to High-Level Disinfect Surgica
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Table C-2Figure C-1Preparing a Dilu
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PREFACE AND ACKNOWLEDGMENTSThis ref
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ONEINTRODUCTIONMAGNITUDE OF THE PRO
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IntroductionFigure 1-3. Incidence o
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Introductionprevalence areas, a sta
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Table 1-2. Reduction in Cumulative
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Introductiontheir performance was t
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Introductionlesions, or a false pos
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IntroductionCompared to other metho
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Introductionsignificantly to women
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IntroductionBelinson JL et al. 2001
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IntroductionMitchell MF et al. 1998
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IntroductionYlitalo N et al. 1999.
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TWOHUMAN PAPILLOMAVIRUS AND CERVICA
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Human Papillomavirus and Cervical C
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THREEPATHOPHYSIOLOGY OF CERVICAL CA
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With the onset of puberty, whichis
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Pathophysiology of Cervical Cancerp
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Pathophysiology of Cervical CancerP
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Pathophysiology of Cervical CancerI
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Pathophysiology of Cervical CancerR
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FOURTALKING WITH WOMEN ABOUTCERVICA
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Talking with Women About Cervical C
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Page 67 and 68: Talking with Women About Cervical C
Page 69 and 70: FIVEPREVENTING INFECTIONS INHEALTHC
Page 71 and 72: Preventing Infections in Healthcare
Page 79 and 80: SIXCLIENT ASSESSMENT AND VIA TESTIN
Page 81 and 82: Client Assessment and VIA TestingFi
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Page 91 and 92: SEVENTREATMENT AND FOLLOWUPBACKGROU
Page 93 and 94: Treatment and Followupregardless of
Page 95 and 96: Treatment and FollowupFigure 7-1. L
Page 97 and 98: Treatment and FollowupTable 7-6. Co
Page 99 and 100: Treatment and FollowupFigure 7-2 is
Page 101 and 102: Treatment and Followup• Regulator
Page 103 and 104: Treatment and FollowupCRYOTHERAPY P
Page 105 and 106: Treatment and FollowupStep 6 Point
Page 107 and 108: Treatment and FollowupNote: When CO
Page 109 and 110: Treatment and FollowupStep 5Advise
Page 111 and 112: Treatment and FollowupBerget A, B A
Page 113 and 114: APPENDIX ATESTS FOR CERVICAL CANCER
Page 115 and 116: Tests for Cervical Cancer Screening
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Page 121 and 122: APPENDIX BSCREENING TEST QUALITIES
Page 123 and 124: Screening Test Qualities and Their
Page 125 and 126: APPENDIX CINFECTION PREVENTION PROC
Page 127 and 128: Infection Prevention Processesfor m
Page 129 and 130: Infection Prevention Processeswith
Page 131 and 132: Infection Prevention ProcessesFigur
Page 133 and 134: Table C-4. Preparing and Using Chem
Page 135 and 136: Infection Prevention ProcessesStora
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Page 139 and 140: APPENDIX DTECHNICAL OVERVIEW OF THE
Page 141 and 142: Technical Overview of the Cryothera
Page 143 and 144: Figure D-5. Removing Protector Tube
Page 145 and 146: Technical Overview of the Cryothera
Page 147 and 148: Figure D-11. Gas Cylinder Secured t
Page 149 and 150: APPENDIX ETROUBLESHOOTING WITH THEC
Page 151 and 152: Table E-1. Following-Up on Commonly
Page 153 and 154: APPENDIX FPROCESSING SURGICAL GLOVE
Page 155 and 156: Processing Surgical GlovesTable F-1
Page 157 and 158: Processing Surgical GlovesSTEP 10:
Page 159 and 160: APPENDIX GPERFORMING BREAST AND PEL
Page 161 and 162: Performing Breast and Pelvic Examin
Page 163 and 164: Figure G-2. Breast Puckering or Dim
Page 165 and 166: Figure G-5. Checking for Nipple Dis
Page 167 and 168: Performing Breast and Pelvic Examin
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Performing Breast and Pelvic Examin
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Figure G-18. Speculum in Place with
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APPENDIX HPERCEIVED BARRIERS TO PRO
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AVAILABILITY OF BASIC SUPPLIES AND
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GLOSSARYAcetic AcidAcetowhite Chang
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PatulousSquamocolumnarJunction (SCJ
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ADDITIONAL READINGAlliance for Cerv
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Reference Manual - IARC Screening Group

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