Reference Manual - IARC Screening Group

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Client Assessment and VIA TestingIn all cases, especially if treatment is provided immediately, counselingmust be as complete as possible to be sure that the woman makes a freeand informed decision. The principles and guidelines for providing highqualitycounseling are described in Chapter 4.REFERENCES AND FURTHER READINGAlliance for Cervical Cancer Prevention (ACCP). 2002. Cervical CancerPrevention Fact Sheet.http://www.path.org/files/RH_visual_screening.pdfCox TJ. 1999. Management of cervical intraepithelial neoplasia. Lancet353(9156): 941–943.Kitchener HC and P Symonds. 1999. Detection of cervical intraepithelialneoplasia in developing countries. Lancet 353: 856–857.Rubin MM. 1999. Cytologic concerns in adolescents: entering thetransformation zone. ADVANCE for Nurse Practitioners 7: 53–54, 56.Sankaranarayanan R et al 1998. Visual inspection of the uterine cervixafter the application of acetic acid in the detection of cervical carcinomaand its precursors. Cancer 83:2150–2156.University of Zimbabwe/JHPIEGO Cervical Cancer Project. 1999. Visualinspection with acetic acid for cervical cancer screening: Test qualities ina primary care setting. Lancet 353 (9156): 869–873.6-12 Cervical Cancer Prevention Guidelines for Low-Resource Settings
SEVENTREATMENT AND FOLLOWUPBACKGROUNDTable 7-1. Cervical Cancer Treatment OptionsA 1995 survey of procedures being used in developing countries tomanage precancerous lesions (dysplasia or CIN) reported thathysterectomy and cone biopsy—both of which involve hospitalizationand are associated with significant procedure-related costs and risks—were the most commonly used methods. Available scientific evidence,however, supports the use of several outpatient procedures (e.g.,cryotherapy and LEEP) as being highly effective (Bishop, Sherris andTsu 1995). The continued use of inpatient methods such as cone biopsyand hysterectomy that are more costly and potentially more risky towomen is in part due to a lack of equipment and supplies to performthese simpler and safer procedures. It is also due in part to the fact thatcervical cancer screening in some countries is not offered at lower levelsof the healthcare system where outpatient treatment could be madeavailable (see Appendix G for details).Table 7-1 shows a comparison of several methods for treatingprecancerous lesions.Procedure Outpatient Anesthesia Electrical Power Nonphysicians Cost aCryotherapy Yes No No Yes LowElectrocautery Yes Yes (local) Yes Yes LowCold cautery (100EC) Yes Yes (local) Yes Yes LowLEEP Yes Yes (local) Yes No ModLaser vaporization Yes Yes (local) Yes No HighCone biopsy No Yes (generalor regional)Hysterectomy No Yes (generalor regional)a Low = < $500, Moderate = $500–1500, High = > $1500b Required for use of operating room lighting and equipmentYes b No HighYes b No HighAs discussed in Chapter 1, the recommended screen-and-treat approachwill have the greatest program impact if it:• can be provided at the lowest level of the healthcare system where themajority of women at risk are located,• can take place during the same visit,• can be provided by nurses or nurse-midwives, andCervical Cancer Prevention Guidelines for Low-Resource Settings 7-1
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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
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Table C-2Figure C-1Preparing a Dilu
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PREFACE AND ACKNOWLEDGMENTSThis ref
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ONEINTRODUCTIONMAGNITUDE OF THE PRO
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IntroductionFigure 1-3. Incidence o
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Introductionprevalence areas, a sta
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Table 1-2. Reduction in Cumulative
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Introductiontheir performance was t
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Introductionlesions, or a false pos
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IntroductionCompared to other metho
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Introductionsignificantly to women
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IntroductionBelinson JL et al. 2001
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IntroductionMitchell MF et al. 1998
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IntroductionYlitalo N et al. 1999.
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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 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
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Page 97 and 98: Treatment and FollowupTable 7-6. Co
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Page 101 and 102: Treatment and Followup• Regulator
Page 103 and 104: Treatment and FollowupCRYOTHERAPY P
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Page 109 and 110: Treatment and FollowupStep 5Advise
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Page 113 and 114: APPENDIX ATESTS FOR CERVICAL CANCER
Page 115 and 116: Tests for Cervical Cancer Screening
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
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Page 139 and 140: 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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Reference Manual - IARC Screening Group

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