Reference Manual - IARC Screening Group

More documents

Recommendations

Info

Introductionare not available. Because LEEP requires more equipment and has morepotentially serious complications than cryotherapy, it may be best suited tofacilities where medical backup is available.There are some differences in effectiveness rates between cryotherapyand LEEP, especially when lesion size is large. A recent randomizedclinical trial, however, showed that, overall, the differences were notstatistically significant (Mitchell et al. 1998). This study alsodemonstrated that LEEP had a higher rate of complication (8%) thancryotherapy (2%). Although these differences were not statisticallysignificant, the main difference in complications among the procedureswas the higher risk of postoperative bleeding with LEEP (3%) versuscryotherapy (0%). In this study, less than 1% of women developedcervical stenosis or pelvic infection regardless of the type of procedureused. Table 1-5 summarizes the advantages and disadvantages ofcryotherapy and LEEP when used in low-resource settings.Table 1-5. Advantages and Disadvantages of Cryotherapy and LEEP for Use inLow-Resource SettingsTREATMENT ADVANTAGES DISADVANTAGESCryotherapy • Effective with mild andmoderate lesions(85–95% cure rate)• Inexpensive• Nonphysician canperform• No local anesthesiarequired• No electricity required• Associated with fewcomplications/side effects• Can be performed duringpregnancyLEEP • Effective (90–96% curerate)• Enables tissue samplingfor diagnosis• Associated with fewcomplications/side effects• Variable success rate withlarge, severe lesions(70–90% cure rate)• Destructive (leaves notissue sample forconfirmatory diagnosis)• Difficult to determineexact amount of tissuedestroyed• Associated with profusewatery discharge for 4–6weeks followingtreatment• Requires access to andresupply of coolant (CO 2or N 2 O)• More expensive thancryotherapy• Primary side effect isperi-operative bleeding(3–8%)• Physician required toperform• Requires local anesthesia• Requires electricity (butcould be battery powered)• Requires resupply ofloops• Should not be performedduring pregnancy1-12 Cervical Cancer Prevention Guidelines for Low-Resource Settings
IntroductionCompared to other methods of treatment, it is relatively easy to traindifferent cadres of healthcare providers to use cryotherapy (Blumenthalet al. 2005). This advantage, combined with its low cost and high efficacyrate, make it appropriate for low-resource settings where only nurses ornurse-midwives are posted.MANAGING PRECANCEROUS CERVICAL DISEASEIn developed countries, to reduce the number of times a woman needs tovisit the clinic, many screening programs have adopted a “see-and-treat”approach to managing precancerous cervical lesions. A screen-and-treatapproach means that after receiving a positive Pap smear result, a womanhas a colposcopic examination and, if colposcopically indicated, isimmediately offered treatment with LEEP without waiting for histologicconfirmation.The management approach described in this manual uses a modifiedversion of the screen-and-treat approach. This “single visit” approachlinks VIA with treatment using cryotherapy. Using this approach, womenwith VIA-positive results and for whom cryotherapy is indicated areoffered treatment. The main advantage of this approach is that it reducesthe number of women who are lost to followup. This loss often occurswhen women have to return to the clinic for the screening test results,diagnostic followup and possible treatment.In addition, performing VIA and cryotherapy during the same visit canoccur at the lowest level of the healthcare system, where the majority ofat-risk women will go at least once in their lives. Given that thehealthcare providers most often posted to such low-level facilities arenurses or nurse-midwives, this approach assumes that both testing andtreatment can be performed competently by these or similar cadres ofhealthcare personnel. The disadvantage of the screen-and-treat approachis that because VIA has a considerable false-positive rate, a proportion ofwomen who are VIA-positive do not have precancerous lesions. Thelower the prevalence of disease in the population being screened, thehigher the number of women with false positive results who may agree toreceiving treatment immediately after VIA.As of 2004, there is now one study with published results from a projectusing the single visit approach in conjunction with VIA.Cervical Cancer Prevention Guidelines for Low-Resource Settings 1-13
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: Introductionlesions, or a false pos
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 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?