Reference Manual - IARC Screening Group

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IntroductionTable 1-6. Provision of Cervical Cancer Prevention Services (by Level of Healthcare Facility and Staff)LEVELSTAFF MAYINCLUDECommunity • Communityleaders a• Women’s groups• Community healthworkersSERVICES• Recognition of importanceof cervical cancer• Referral to facilities wherescreening is available• Palliative (supportive)careREQUIREMENTSCommunity mobilizationInformation, education, andcommunication: radiomessages, pamphlets, andother public informationPrimary Level b(Primary Health,Family Planning orPolyclinics)First Referral Level(District Hospital)Secondary andTertiary Level(Regional orReferral Hospital)Nurses, midwives orphysician assistantsAbove plus:• Medical officers• Nurse midwives• (Ob/Gynspecialists)Above plus:• Ob/Gyn specialists• (Ob/Gynoncologists)• (Radiotherapist)Above activities, plus:• Counseling (sexual andcancer risk)• VIA• Treatment withcryotherapy or referralAbove activities (VIA,cryotherapy), plus:• Visual Inspection of thecervix using acetic acidand low-powermagnification (VIAM) orHPV testing• LEEP or cone biopsy• Simple hysterectomyAbove activities, plus:• Full diagnostics(colposcopy, biopsy,HPV)• Radical surgery• Radiotherapya Knowledgeable people, local nongovernmental organizations and private groupsb Level where VIA and cryotherapy are appropriateTraining and access tonecessary suppliesPelvic examInfection preventionBasic equipment, CO 2 andsuppliesLimited specialty hospitalLab with HPV assessmentcapabilityLEEP machine and thinwire loopsGeneral anesthesiaFull specialty hospitalRadiation therapy servicesChemotherapyREFERENCESAlliance for Cervical Cancer Prevention (ACCP). 2004. Planning andImplementing Cervical Cancer Prevention and Control Programs: AManual for Managers. ACCP.Alliance for Cervical Cancer Prevention (ACCP). 2003. Effectiveness,safety, and acceptability of cryotherapy: A systematic literature review.Cervical Cancer Prevention Issues in Depth, No. 1. (January).American College of Obstetricians and Gynecologists. 2004. ACOGStatement of Policy: Cervical cancer prevention in low-resource settings.Obstetrics & Gynecology 103: 607–609.1-16 Cervical Cancer Prevention Guidelines for Low-Resource Settings
IntroductionBelinson JL et al. 2001. Cervical cancer screening by simple visualinspection after acetic acid. Obstetrics & Gynecology 98(3): 441–444.Blumenthal et al. 2005. Training for cervical cancer prevention programsin low-resource settings: Focus on visual inspection with acetic acid andcryotherapy [Review]. International Journal of Gynecology andObstetrics. 89(Suppl 2): S30–S37.Bosch FX et al. 1995. Prevalence of human papillomavirus in cervicalcancer: A worldwide perspective. Journal of the National CancerInstitute 87(11): 796–802.CDC. 1992. 1993 Revised classification system for HIV infection andexpanded surveillance case definition for AIDS among adolescents andadults. Morbidity and Mortality Weekly Report (MMWR). December 18,1992.Denny L et al. 2002. Direct visual inspection for cervical cancerscreening: an analysis of factors influencing test performance. Cancer94(6): 1699–1707.Denny L et al. 2000. Evaluation of alternative methods of cervical cancerscreening for resource-poor settings. Cancer 89: 826–833.Ellerbrock TV et al. 2000. Incidence of cervical squamous intraepitheliallesions on HIV-infected women. Journal of the American MedicalAssociation 283(8): 1031–1037.Ferlay J et al. 2001. Globocan 2000: Cancer Incidence, Mortality andPrevalence Worldwide. IARC Press: Lyon, France.Gaffikin L et al. 2003. Performance of visual inspection with acetic acidfor cervical cancer screening: A qualitative summary of evidence to date.Obstetrical and Gynecological Survey 58(8): 543–550.Gaffikin L et al. (eds). 1997. Alternatives for Cervical Cancer Screeningand Treatment in Low-Resource Settings. Workshop Proceedings (21–22May). JHPIEGO: Baltimore, Maryland.Goldie SJ et al. 2001. Policy analysis of cervical cancer screeningstrategies in low-resource settings: Clinical benefits and costeffectiveness.Journal of the American Medical Association 285: 3107–3115.Groopman J. 1999. Contagion. The New Yorker 75(26): 44–49.Hildesheim A et al. 1999. Risk factors for rapid-onset cervical cancer.American Journal of Obstetrics and Gynecology 180 (3): 571–577.Cervical Cancer Prevention Guidelines for Low-Resource Settings 1-17
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: Introductionsignificantly to women
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
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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
Page 69 and 70: FIVEPREVENTING INFECTIONS INHEALTHC
Page 71 and 72: Preventing Infections in Healthcare
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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 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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innovating to save liveswww.jhpiego
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