Reference Manual - IARC Screening Group

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Human Papillomavirus and Cervical Cancerexamining a biopsy specimen of cervical tissue. In some women thesepremalignant cells, if left untreated, will slowly replace the normal cellson the surface of the cervix and CIS will develop. Finally, when the cellsbegin to grow through the normal surface layer into the muscle anddeeper tissues, full-blown cancer is present.RISK FACTORS FOR CERVICAL CANCEREpidemiologic studies have identified a number of factors that play asignificant role in the development of CIN, a precursor to cervical cancer(Palank 1998). As shown in Table 2-1, both the type and the pattern ofsexual activity, especially in teenagers, are major factors in determiningwhether a person becomes infected with HPV. As a result of relaxedattitudes about sexuality among adolescents in many cultures, the numberof sexual partners that teenagers have before age 20 can be quite large,and each of their partners also may have had multiple partners. As aconsequence, this pattern of sexual activity increases their risk ofexposure to STIs, especially HPV.Table 2-1. Risk Factors for Cervical CancerRISK FACTORSSexual activity (< 20 years)Multiple sexual partnersExposure to STIMother or sister with cervical cancerPrevious abnormal Pap smearSmokingImmunosuppression:• HIV/AIDS• Chronic corticosteroid use (asthma and lupus)Another risk factor is having a blood relative (mother or sister) withcervical cancer. Magnusson, Sparen and Gyllensten (1999) compared theincidence of dysplasia and CIS in relatives of women with disease and inage-matched controls. They found a significant familial clustering amongbiological, but not adoptive, relatives. For biological mothers comparedto control cases, the relative risk was 1.8, whereas for adoptive mothersthe relative risk was not significantly different from controls (1.1). Forbiological full sisters, the relative risk was even higher (1.9), versus 1.1for nonbiological sisters. These data provide strong epidemiologicalevidence for a genetic link to the development of cervical cancer and itsprecursors.2-4 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Human Papillomavirus and Cervical CancerSuppression of the immune system due to HIV infection also is animportant risk factor because it makes the cells lining the lower genitaltract (vulva, vagina and cervix) more easily infected by the cancerinducingtypes of HPV (Stentella et al. 1998). Other less commonconditions that cause immunosuppression include those requiring chroniccorticosteroid treatment, such as asthma or lupus (McDonald 1999).Women also increase their risk for CIN by engaging in other behaviorsknown to suppress the immune system. These include the use ofrecreational drugs, alcohol and cigarettes. The latter is particularlyimportant because while a decrease in smoking among men has occurred,the number of women who smoke has increased dramatically in recentyears—especially in teenage girls (McDonald 1999). Nicotine and thebyproducts of smoking are thought to increase a woman’s relative risk forcervical cancer by concentrating in the cervical mucus and decreasing theimmune capability of Langerhan’s cells to protect cervical tissue frominvading oncogenic factors, such as HPV infection (Ylitalo et al. 1999).As mentioned in Chapter 1, there is substantial evidence that HIVpositivewomen are at increased risk of developing cervical cancer aswell (Judson 1992). In two studies, both from high HIV prevalence areas,a statistically significant association between HIV and CIN was reported(Table 1-1, page 1-5). Because the number of adolescents, as well asadults, with HIV is rising in most countries where cervical cancer islargely untreated, cervical cancer rates are expected to continueincreasing, especially in areas where STI and HIV/AIDS rates are high.Finally, in many developing countries, women who have abnormal Papsmears frequently do not receive treatment at an early stage whencervical cancer could be prevented because:• there are long delays in reading and reporting the results;• it is difficult to locate the patient once the report becomes available;• the cost of treatment is not affordable for many women, even whensimple outpatient procedures are used; and• there is a lack of equipment as well as healthcare providers trained touse and maintain it.As a consequence, even in countries where Pap smears are available,many women may not get the treatment they need it.PREVENTING CERVICAL CANCERAs mentioned above, HPV is the most prevalent sexually transmittedinfection in the world. Although condoms and other safe-sex practicesprotect against many STIs, including HIV/AIDS, they are not nearly aseffective in preventing HPV infection. This is because the papillomavirusCervical Cancer Prevention Guidelines for Low-Resource Settings 2-5
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: Human Papillomavirus and Cervical C
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Page 45 and 46: Human Papillomavirus and Cervical C
Page 47 and 48: THREEPATHOPHYSIOLOGY OF CERVICAL CA
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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
Page 79 and 80: SIXCLIENT ASSESSMENT AND VIA TESTIN
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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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