Reference Manual - IARC Screening Group

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Introductionitching or burning in the genital area. After a woman becomes infectedwith HPV, the infection may remain locally stable, may regressspontaneously, or if the cervix is affected, may develop into low-gradesquamous intraepithelial lesions (LGSILs), which are also called mildcervical intraepithelial neoplasia (CIN I) or early dysplasia. Most lowgrade(CIN I) lesions disappear without treatment or do not progress,particularly those that occur in younger women (Figure 1-2). It isestimated that for every 1 million women infected, 10% (about 100,000)will develop precancerous changes in their cervical tissue. Theseprecancerous changes are observed most frequently in women betweenages 30 and 40.Figure 1-2. Natural History of Cervical Cancer—Current UnderstandingSource: PATH 1997.About 8% of the women who develop these changes will develop precancerlimited to the outer layers of the cervical cells (carcinoma in situ[CIS]), and about 1.6% will develop invasive cancer unless theprecancerous lesion or CIS is detected and treated. Progression tocervical cancer from high-grade squamous intraepithelial lesions(HGSILs) generally takes place over a period of 10 to 20 years (Figure1-3). Although rare, some precancer lesions become cancerous over ashorter time interval—within a year or two (Hildesheim et al. 1999).Although HPV-related lesions (e.g., warts) can be treated, currently thereis no cure for HPV infection. Once infected, a person is most likelyinfected for life. In most cases, an active infection is controlled by theimmune system and becomes dormant over time. It is not possible,however, to predict whether or when the virus will become active again.1-2 Cervical Cancer Prevention Guidelines for Low-Resource Settings
IntroductionFigure 1-3. Incidence of Cervical Cancer, by AgeSource: Ferlay et al. 2001.HIV/AIDS, HPV INFECTION, AND CERVICAL CANCERGlobally, the HIV epidemic continues to take its toll on men and women.The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimatesthat 39.5 million people were living with HIV/AIDS (PLWHA) in 2006,and almost half of the adults (48%) afflicted with the disease are women(UNAIDS 2006). Heterosexual contact is the essential mode of HIVtransmission in an increasing number of new cases. Its confluence withHPV infection, one of the most common STIs, affects the natural historyof HPV and its associated diseases. A number of studies haveconsistently shown that in HIV-seropositive women, HPV infection isdetected more frequently and tends to resolve with more difficulty than inHIV-seronegative women—and HPV-associated diseases includinggenital warts, dysplasias and squamous cell cancers are more difficult totreat (Moscicki and Jay 2000). A 2000 study highlighted the importanceof screening programs after finding that one in five HIV-infected womendeveloped dysplasias within three years (Ellerbrock TV et al. 2000).According to a recent World Health Organization (WHO) publication, inareas where HIV is endemic, cervical cancer screening results may bepositive for precancerous lesions in up to 15–20% of the targetpopulation (WHO 2006).In 1993, the US Centers for Disease Control and Prevention (CDC)included cervical squamous cell cancer in the expanded definition of anAIDS-defining illness (CDC 1992). Antiretroviral (ARV) treatment hasimproved the quality of life of PLWHAs, allowing them to live longer.Where there is increased access to effective ARVs, high-qualityreproductive health care becomes ever more important—includingscreening for cervical cancer. While it is known that HIV accelerates theprogression of precancerous lesions, the effect of highly activeantiretroviral therapies (HAART) on this progression is not yet clear.Cervical Cancer Prevention Guidelines for Low-Resource Settings 1-3
Page 1: Cervical Cancer PreventionGuideline
Page 5: TABLE OF CONTENTSPREFACE AND ACKNOW
Page 8: How to High-Level Disinfect Surgica
Page 11 and 12: Table C-2Figure C-1Preparing a Dilu
Page 13 and 14: PREFACE AND ACKNOWLEDGMENTSThis ref
Page 15: ONEINTRODUCTIONMAGNITUDE OF THE PRO
Page 19 and 20: Introductionprevalence areas, a sta
Page 21 and 22: Table 1-2. Reduction in Cumulative
Page 23 and 24: Introductiontheir performance was t
Page 25 and 26: Introductionlesions, or a false pos
Page 27 and 28: IntroductionCompared to other metho
Page 29 and 30: Introductionsignificantly to women
Page 31 and 32: IntroductionBelinson JL et al. 2001
Page 33 and 34: IntroductionMitchell MF et al. 1998
Page 35 and 36: IntroductionYlitalo N et al. 1999.
Page 37 and 38: TWOHUMAN PAPILLOMAVIRUS AND CERVICA
Page 39 and 40: Human Papillomavirus and Cervical C
Page 47 and 48: THREEPATHOPHYSIOLOGY OF CERVICAL CA
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Page 51 and 52: Pathophysiology of Cervical Cancerp
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Page 59 and 60: FOURTALKING WITH WOMEN ABOUTCERVICA
Page 61 and 62: Talking with Women About Cervical C
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Talking with Women About Cervical C
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FIVEPREVENTING INFECTIONS INHEALTHC
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Preventing Infections in Healthcare
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SIXCLIENT ASSESSMENT AND VIA TESTIN
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Client Assessment and VIA TestingFi
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Client Assessment and VIA TestingIN
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Client Assessment and VIA Testingst
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Client Assessment and VIA Testingsp
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Client Assessment and VIA Testingth
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SEVENTREATMENT AND FOLLOWUPBACKGROU
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Treatment and Followupregardless of
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Treatment and FollowupFigure 7-1. L
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Treatment and FollowupTable 7-6. Co
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Treatment and FollowupFigure 7-2 is
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Treatment and Followup• Regulator
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Treatment and FollowupCRYOTHERAPY P
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Treatment and FollowupStep 6 Point
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Treatment and FollowupNote: When CO
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Treatment and FollowupStep 5Advise
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Treatment and FollowupBerget A, B A
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APPENDIX ATESTS FOR CERVICAL CANCER
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Tests for Cervical Cancer Screening
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APPENDIX BSCREENING TEST QUALITIES
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Screening Test Qualities and Their
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APPENDIX CINFECTION PREVENTION PROC
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Infection Prevention Processesfor m
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Infection Prevention Processeswith
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Infection Prevention ProcessesFigur
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Table C-4. Preparing and Using Chem
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Infection Prevention ProcessesStora
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Infection Prevention Processes• h
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APPENDIX DTECHNICAL OVERVIEW OF THE
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Technical Overview of the Cryothera
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Figure D-5. Removing Protector Tube
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Technical Overview of the Cryothera
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Figure D-11. Gas Cylinder Secured t
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APPENDIX ETROUBLESHOOTING WITH THEC
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Table E-1. Following-Up on Commonly
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APPENDIX FPROCESSING SURGICAL GLOVE
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Processing Surgical GlovesTable F-1
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Processing Surgical GlovesSTEP 10:
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APPENDIX GPERFORMING BREAST AND PEL
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Performing Breast and Pelvic Examin
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Figure G-2. Breast Puckering or Dim
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Figure G-5. Checking for Nipple Dis
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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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