Reference Manual - IARC Screening Group

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Talking with Women About Cervical CancerWHO SHOULD TALK WITH A WOMANProviders who might talk to women about cervical cancer includephysicians, nurses and other persons who work in a health center,Maternal and Child Health/Family Planning clinic, STI clinic or anyother healthcare facility providing services to women. All providers canlearn counseling techniques that will help them be more understandingand sensitive toward clients. Providers who take reproductive healthhistories, perform gynecological examinations, make diagnoses andprescribe treatment should learn how to ask and answer questions aboutcervical cancer in a well-informed, honest and culturally sensitive way.BEING A GOOD COUNSELORA good counselor:• Encourages maximum participation and involvement by the woman(or couple) and helps her make her own decision• Is an information giver, facilitator and problem solver; suggestsalternatives; helps the woman analyze and choose from knownoptions; does not prescribe solutions; and helps her understand thatshe is making her own choice or decision• Helps the woman to reveal her personality and life situation ratherthan make assumptions• Determines her concerns and other issues that could be barriers toeffective learningGeneral AdviceWhen CounselingA woman may become embarrassed when discussing testing for cervicalcancer because it involves having a pelvic examination. Therefore, try toset the tone of the visit in a low-key, nonpressured manner, and assureher that the conversation is confidential. Finally, be sensitive to anycultural and religious considerations and respect her views. Additionaltips for talking with a woman (or couple) include the following:• Listen to what the woman has to say and encourage her to express herconcerns; try not to interrupt her.• Let the woman know that she is being listened to and understood.• Use supportive nonverbal communication, such as nodding andsmiling.• Answer her questions directly in a calm, reassuring manner.• Keep the message simple by using short sentences.4-4 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Talking with Women About Cervical Cancer• Avoid sophisticated medical terms; instead, use words that thewoman will understand.• Give the woman written information (if available and appropriate) toremind her of instructions.• Finally, ask her to repeat back to you the key points to ensure herunderstanding.COUNSELING PRIOR TO VIA TESTINGOnce a woman has agreed to be examined, explain in detail the VIAprocedure and describe what steps will be taken should an abnormality bedetected (see Figure 6-1, page 6-3). Tell her that treatment of many typesof precancerous lesions that may be identified can be performedimmediately, if she desires.A woman who is interested in being tested by VIA should be giveninformation about the following:• The nature of cervical cancer as a disease and consequence of a HPVinfection• Availability of HPV vaccines and who can benefit most from them• Risk factors for the disease• The role and importance of VIA testing• Consequences of not being tested• Treatment options if the VIA test is abnormal.While performing the VIA test, continually reassure the woman andinform her of the findings, including whether immediate treatment withcryotherapy may be needed. If the woman tests negative for VIA, counselher about the meaning of the test results and when to return for futurescreening. The length of time until her next screening test should beconsistent with local or national guidelines.COUNSELING PRIOR TO CRYOTHERAPYAll women have a right to decide freely whether or not to receivetreatment. In some countries, written consent may be required for alltreatment procedures. The health worker obtaining the woman’s verbalconsent for cryotherapy should follow these steps:• Explain in detail, in a nonthreatening manner and in language thewoman can understand, the cryotherapy procedure, its risks, benefits,likelihood of success and alternatives (Table 4-1).Cervical Cancer Prevention Guidelines for Low-Resource Settings 4-5
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Cervical Cancer PreventionGuideline
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TABLE OF CONTENTSPREFACE AND ACKNOW
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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 and 40: Human Papillomavirus and Cervical C
Page 47 and 48: THREEPATHOPHYSIOLOGY OF CERVICAL CA
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Page 51 and 52: Pathophysiology of Cervical Cancerp
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Page 59 and 60: FOURTALKING WITH WOMEN ABOUTCERVICA
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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
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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
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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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Reference Manual - IARC Screening Group

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