Reference Manual - IARC Screening Group

More documents

Recommendations

Info

IntroductionTable 1-4. Test Qualities of VIA when Performed as Primary <strong>Screening</strong> Method in Low-Resource SettingsSTUDY COUNTRY NUMBEROF CASESDETECTION OFHGSIL a AND CANCERSENSITIVITY bSPECIFICITY bBelinson (2001) China 1,997 71% 74%Denny et al. (2000) South Africa 2,944 67% 84%Sankaranarayanan et al. (1999) India 1,351 96% 68%University ofZimbabwe 2,148 77% 64%Zimbabwe/JHPIEGO (1999)Sankaranarayanan et al. (1998) India 2,935 90% 92%Megevand et al. (1996) South Africa 2,426 65% 98%Sankaranarayanan and Wesley(unpublished)India 2,462 84% 90%Sankaranarayanan et al. (2004) India 56,939 76.8% 85.5%aHGSIL = high-grade squamous intraepithelial lesionb Estimated from the number provided in the manuscript and does not reflect adjustment(s) for verification bias.Adapted from: Belinson et al. (2001); Denny et al. (2000); Megevand et al. (1996); Sankaranarayanan et al. (1999);Sankaranarayanan et al. (1998); Sankaranarayanan and Wesley (unpublished); and University of Zimbabwe/JHPIEGOCervical Cancer Project (1999).In summary, VIA can be considered for use in low-resource settingsbecause it:• Can effectively identify most precancerous lesions• Is noninvasive, easy to perform and inexpensive• Can be performed by all levels of healthcare workers in almost anysetting• Provides immediate results that can be used to inform decisions andactions regarding treatment• Requires supplies and equipment that are readily available locallyTREATMENTIn order for cervical cancer prevention programs to be truly effective andof public health value, testing should be linked to appropriate treatmentfor any precancerous lesions detected.What Lesions Needto Be Treated?There is clear consensus that high-grade (CIN II–III) lesions should betreated because they are more likely than low-grade lesions (CIN I) toprogress to cancer. Published studies indicate that most low-grade lesionswill regress spontaneously and thus do not require treatment. When closefollowup or histological confirmation is not feasible or possible,treatment of acetowhite lesions (which could be low-grade or high-grade1-10 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Introductionlesions, or a false positive) may be advisable, particularly if the treatmentis not highly invasive or associated with serious side effects,complications or long-term sequellae.FACTORS AFFECTING CHOICE OF TREATMENTBecause precancerous lesions of the cervix occur most frequently in womenwho are still in their childbearing years—30s and 40s—it is important torecognize and consider the method’s effect on fertility as well as its safety inpregnancy. Other factors to be considered include the following:• Method effectiveness• Safety and potential side effects• Who is allowed (or legally able) to provide treatment, and whattraining they need to become qualified to provide it• The size, extent, severity and site of the lesion• Acceptability (to women) of treatment offered• Equipment and supplies required• Availability of method• Cost or affordability of methodInpatient VersusOutpatientTreatmentIn developed countries, treatment of a precancerous cervical conditionhas changed from an inpatient surgical procedure (e.g., cone biopsy andhysterectomy) to simpler, safer outpatient procedures, such ascryotherapy, laser vaporization, electrosurgery and loop electrosurgicalexcision procedure (LEEP). Inpatient procedures are associated withserious complications, such as hemorrhage and infection. In addition,these procedures are expensive and require anesthesia, operating roomsand hospital beds.Over the years, there has been much discussion about which outpatientmethod is best in terms of safety, efficacy and cost. Outpatient methods canbe used either to destroy tissue (cryotherapy, laser vaporization orelectrosurgery) or remove it (LEEP). Cryotherapy, which freezes cells usinga liquid coolant (compressed carbon dioxide or nitrous oxide gas), is veryeffective in treating high-grade (CIN II–III) lesions, has a low rate ofcomplications, does not require electricity, and is easy to use andinexpensive. These factors make cryotherapy most suitable for low-resourcesettings compared to other outpatient methods. Cryotherapy, however, doesnot provide a tissue specimen for histologic examination. During LEEP, aportion of or the entire squamocolumnar junction (SCJ) is removed, therebyproviding a surgical specimen and reducing the possibility of missinginvasive cancer. In many low-resource settings, however, the facilities,equipment and personnel necessary to perform histologic evaluation oftenCervical Cancer Prevention Guidelines for Low-Resource Settings 1-11
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: Introductiontheir performance was t
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
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 69 and 70: FIVEPREVENTING INFECTIONS INHEALTHC
Page 71 and 72: Preventing Infections in Healthcare
Page 73 and 74: Preventing Infections in Healthcare
Page 75 and 76:
Preventing Infections in Healthcare
Page 77 and 78:
Preventing Infections in Healthcare
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 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Figure G-18. Speculum in Place with
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
APPENDIX HPERCEIVED BARRIERS TO PRO
Page 207 and 208:
AVAILABILITY OF BASIC SUPPLIES AND
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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?