Reference Manual - IARC Screening Group

More documents

Recommendations

Info

IntroductionTREATING WOMEN WITH UNCONFIRMED DISEASEIn studies conducted to date in relatively high prevalence areas, thepositive predictive value of VIA has been between 10% and 35%. Thismeans, using a single visit or screen-and-treat approach, that between 6.5to 9 of every 10 women in similar populations who test positive on VIAdo not have a high-grade (CIN II–III) lesion and would be offeredimmediate treatment (Sankaranarayanan 2001). Because of the lowmorbidity reported in published studies associated with cryotherapy,however, treatment with cryotherapy of all women with a VIA-positiveresult may be cost-effective because of the likelihood of preventing thedisease from progressing to cervical cancer (Goldie et al. 2001;Mandelblatt et al. 2001). In settings where women are not likely to returnfor any followup after testing, some degree of over-treatment may benecessary in order to provide treatment to those who have disease that ismore likely to progress to cancer (Lonky et al. 1997).While over-treatment of some women may translate into extra costs tothe healthcare system as well as the unnecessary discomfort and potentialside effects for women with false-positive results, most women areunlikely to have the opportunity to have a diagnostic test confirming theirtrue disease state. In such an environment, offering to treat suspiciousprecancerous lesions, which in actuality represent either no disease, lowgrade(CIN I) lesions or high-grade (CIN II–III) lesions, also could beconsidered a preventive measure against developing of cervical cancer.This is because cryotherapy has the potential to significantly reduce theprobability of developing cancer or precancerous lesions (Lonky et al.1997). In many low-resource settings, it is standard practice to usecryotherapy or electrocautery to treat chronic cervicitis. In suchinstances, either procedure resolves cervicitis and possibly reducescervical ectopy, which could have a long-term protective effect againstHPV and HIV. Finally, recurrences of disease after cryotherapy are morelikely to involve one or more types of HPV other than the type present atthe time of treatment. By contrast, recurrences seen after excisionaltreatment (e.g., LEEP) tend to be of the same type (Nuovo, Banbury andCalayag 1991). Thus, if a woman who is VIA-positive is infected by oneof the high-risk HPV types and is treated by cryotherapy, this treatmentcould eliminate her existing oncogenic HPV type and possibly preventher from ever developing a precancerous lesion.LINKS TO OTHER REPRODUCTIVE HEALTH SERVICESLinking cervical cancer screening and treatment services with otherreproductive health services is essential and logical. Yet these servicesare completely separate in much of the world. This separation leaveswomen without access to reproductive healthcare and contributes1-14 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Introductionsignificantly to women’s poor overall health status. The integration ofcervical cancer prevention with existing reproductive health servicesclearly answers the call to make cervical cancer prevention “accessiblethrough the primary healthcare system, to all individuals of appropriateages as soon as possible” (ICPD 1994). Testing, treatment and thenecessary followup care for gynecological cancers are considered anintegral part of reproductive health by a range of internationalorganizations and were included in the Cairo Programme of Action(Jones 1999).Table 1-6 provides information on the cervical cancer screening andtreatment services that are appropriate at different healthcare facilitylevels and highlights the need for community involvement to promoteawareness of cervical cancer prevention. There is now general agreementthat the interventions needed to save the lives and preserve the health ofwomen must be part of a broad strategy to improve reproductive health.This strategy implies that interventions should be applied holisticallywithin a general health context that promotes equity in access to andquality of care. Finally, in order to make the best use of existingresources, these essential services should be integrated into and operatethrough the existing primary healthcare systems.As shown in Table 1-6, the district-level health system is the basic unit indeveloping countries for planning and implementing the interventionsoutlined in this manual. The district provides a mechanism for linkingfamilies and communities with health centers and hospitals in afunctional, cost-effective manner. Through district-based implementationof interventions, it is possible to ensure that health services are availableas close as possible to people’s homes. Treatment procedures forprecancerous disease of the cervix should be carried out by the healthcareworker who is closest to the community and competent to perform themsafely and effectively. The person best equipped to provide communitybased,technologically appropriate, safe and cost-effective care to womenduring their reproductive lives is usually the nurse or midwife who worksin the community near the women she serves. She can ensure that thehealthcare system serves women fairly and effectively and that the healthservices available respond to the needs of the people.More information concerning programmatic aspects related to startingand managing a cervical cancer prevention program can be found inPlanning and Implementing Cervical Cancer Prevention and ControlPrograms: A <strong>Manual</strong> for Managers, published in 2005 by the Alliancefor Cervical Cancer Prevention.Cervical Cancer Prevention Guidelines for Low-Resource Settings 1-15
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: IntroductionCompared to other metho
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 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?