Reference Manual - IARC Screening Group

SIXCLIENT ASSESSMENT AND VIA TESTINGBACKGROUNDVIA is one way of performing cervical cancer testing. As discussed inChapter 1, its advantages include the simplicity of the technique and theability to provide women with an immediate result. As with any othermedical procedure, training with guided practice is required in order toperform VIA competently, but such training can be given easily to almostany level of healthcare provider.WHO SHOULD BE TESTEDTesting for cervical cancer or its precursors is recommended for anywoman between the ages of 30 and 45. Cervical cancer rates peakamong women between the ages of 40 and 50, so testing should takeplace during the ages in which detecting a precancerous lesion is mostlikely, normally 10 to 20 years earlier.A number of risk factors are associated with the development of cervicalcancer and, presumably, its precursors. Risk factors include thefollowing:• Young age at onset of sexual activity (age < 20)• Multiple sexual partners (woman or partner)• History or presence of an STI, such as chlamydia or gonorrhea, andespecially HIV/AIDS• Mother or sister with cervical cancer• Previous abnormal Pap smear• SmokingIn addition, as discussed in Chapter 2, women who have animmunosuppressive disorder (e.g., HIV/AIDS) or who use corticosteroidschronically (e.g., for treatment of asthma or lupus) are at increased risk ofdeveloping cervical cancer if they have HPV (Rubin 1999).Women with any of these risk factors may be the most important group toreceive testing and treatment services in low-resource settings. In fact,focusing testing and treatment services on women who are between 30and 45 or have risk factors such as a high risk for STI is likely to improvethe positive predictive value of VIA. In addition, because rates of diseaseare likely to be higher in these groups, the chances of detectingCervical Cancer Prevention Guidelines for Low-Resource Settings 6-1