Reference Manual - IARC Screening Group

More documents

Recommendations

Info

Perceived Barriers to Providing Cervical Cancer Prevention ServicesCost andAvailability ofEquipmentSince the survey found that clinicians still rely heavily on cone biopsyand hysterectomy, even to treat low-grade lesions, the reasons wereexplored for why nearly 60% of respondents indicated that cost ofequipment was a key barrier to treatment. Survey results revealed thatequipment prices varied widely among countries and presumablydepended on local availability of equipment and supplies. Still, investingin lower-cost outpatient methods to treat preinvasive conditions is likelyto lead to considerable savings because the equipment lasts for manyyears and the incidence of advanced cases should decrease, thus reducingthe demand for more expensive therapy. Finally, survival rates will bemuch greater, resulting in a lower cost per Discounted Health Life Year(DHLY) gained. 4Obtaining supplies for some treatment methods also is difficult.Inability toFollowup WomenLack of TrainedPersonnelReferral and followup systems are essential to developing an effectivecervical cancer screening and treatment program. A test and treatapproach could reduce the number of clinic visits required for evaluationand treatment, which can take many weeks (and is also perceived as abarrier to care). Estimates of the percentage of women who actuallyreturn for required post-treatment followup varied considerably.Followup rates can be increased, however, if outreach programs areestablished specifically to encourage women to return for followup care.According to the survey, at present gynecologists rather than otherclinicians usually provide treatment in all regions.Because many countries have a shortage of gynecologists, as well asphysicians in general, reliance on them to perform treatment ofprecancerous lesions probably has hindered efforts to expand cervicalcancer screening and treatment beyond urban areas. If mid-levelpractitioners, such as nurse-midwives, could be trained to performscreening and perhaps simple outpatient treatment such as cryotherapy,coverage could be expanded in many settings. The feasibility of trainingnurses and midwives to perform screening and treatment, however,depends on local policies regarding healthcare delivery, and should beevaluated within the local context. Still, this approach warrants furtherexploration wherever feasible.Women’s Resistanceto TreatmentOnly a small proportion of respondents (about 15%) cited women’sresistance as an important barrier. Perceived resistance by women,however, may be related to lack of education and available informationfor women about cervical cancer, which also was mentioned as a barrierby some respondents.4 DHLY = number of years between the age at which death would have occurred from cervical cancer and theindividual’s expected age at death, with years gained discounted at 3% each year.H-2 Cervical Cancer Prevention Guidelines for Low-Resource Settings
AVAILABILITY OF BASIC SUPPLIES AND EQUIPMENTPerceived Barriers to Providing Cervical Cancer Prevention ServicesAvailability of supplies, equipment and trained staff varies amongregions. For examples, survey findings suggests that the majority offacilities represented by the respondents are equipped with examiningtables, specula, lights and electricity; however, facilities in Africancountries represented in the survey were not as well-equipped with theseitems as those in other regions. Most facilities have access to a pathologylaboratory. A majority are equipped with local anesthesia andconsumable supplies, but some experienced shortages.Although facilities represented in the survey seem to have basicequipment to provide some type of treatment, respondents still indicatedthat for the numbers of women requiring treatment, insufficient supplies,facilities and equipment remained a barrier to service delivery. Inparticular, respondents cited crowded clinic conditions and long waitingtime for services and laboratory results as being important deterrents toproviding treatment services.SUMMARYData from this survey suggest that in all regions, but particularly inAfrica, low-cost, outpatient procedures such as cryotherapy and LEEPare not being used sufficiently. Rather, clinicians still rely heavily oncone biopsy and hysterectomy, even to treat low-grade lesions. Thissuggests that education of providers to help change their perceptions ofthe various methods, and ultimately their methods of choice, is crucial.Heavy reliance on inpatient methods also is likely due to limited accessto alternative methods and lack of resources to support early detectionand treatment of preinvasive conditions. In addition, inability to followup women was cited as another important barrier; this highlights the needto develop an effective, single-visit cervical cancer screening andtreatment program.Regionally, it appears that countries in Asia, Latin America and theCaribbean may have greater access to cryotherapy and LEEP thanAfrican countries, as well as greater capacity to incorporate thesemethods into their programs. This suggests that strategies for introducingoutpatient treatment will probably differ among these regions, and thatintroduction efforts in Africa, in particular, will need to be carefullyconsidered in the context of limited resources. In all regions, however,introducing outpatient methods and clear guidelines for their use couldimprove overall quality of care and extend treatment services beyondcentral facilities, thereby reaching more women who need them.Cervical Cancer Prevention Guidelines for Low-Resource Settings H-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 and 16:
ONEINTRODUCTIONMAGNITUDE OF THE PRO
Page 17 and 18:
IntroductionFigure 1-3. Incidence o
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 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
THREEPATHOPHYSIOLOGY OF CERVICAL CA
Page 49 and 50:
With the onset of puberty, whichis
Page 51 and 52:
Pathophysiology of Cervical Cancerp
Page 53 and 54:
Pathophysiology of Cervical CancerP
Page 55 and 56:
Pathophysiology of Cervical CancerI
Page 57 and 58:
Pathophysiology of Cervical CancerR
Page 59 and 60:
FOURTALKING WITH WOMEN ABOUTCERVICA
Page 61 and 62:
Talking with Women About Cervical C
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
FIVEPREVENTING INFECTIONS INHEALTHC
Page 71 and 72:
Preventing Infections in Healthcare
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
SIXCLIENT ASSESSMENT AND VIA TESTIN
Page 81 and 82:
Client Assessment and VIA TestingFi
Page 83 and 84:
Client Assessment and VIA TestingIN
Page 85 and 86:
Client Assessment and VIA Testingst
Page 87 and 88:
Client Assessment and VIA Testingsp
Page 89 and 90:
Client Assessment and VIA Testingth
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
Page 117 and 118:
Page 119 and 120:
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
Page 137 and 138:
Infection Prevention Processes• h
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 181 and 182: Figure G-18. Speculum in Place with
Page 205: APPENDIX HPERCEIVED BARRIERS TO PRO
Page 209 and 210: GLOSSARYAcetic AcidAcetowhite Chang
Page 211 and 212: PatulousSquamocolumnarJunction (SCJ
Page 213 and 214: ADDITIONAL READINGAlliance for Cerv
Page 216: innovating to save liveswww.jhpiego
show all

Reference Manual - IARC Screening Group

Create successful ePaper yourself

Delete template?

Save as template?