Cervical Cancer Screening Testing: Appropriate Technology for Resource Limited Countries

Slide 1:Cervical Cancer Screening & Testing: Appropriate Technology for Resource Limited Countries Kimberly Adams Tufts, DNP, WHNP-BC, FAAN From the nursing perspective health promotion and disease prevention services are at the core of quality driven and evidence-based health care. And technology must be used to advance quality of life and increase productive life years. As a nurse and women’s health care nurse practitioner I have found no where that no where is this perspective needed more than in the arena of primary and secondary prevention of cervical cancer. CERVICAL CANCER is an important area of action for any cancer control program because of the burden of disease, and the potential for effective prevention via screening. In my 25 or more years in women’s health I have seen great strides made in the area of women’s health care; several new contraceptive methods have emerged, standards and protocols have been revised to reflect more of a focus on health rather than a curative only focus. I must say that although there has been progress made regarding the incidence and prevalence of Cervical Ca and that progress has primarily occurred in United States and Western Europe while the burden of cervical cancer continues to impact quality of life and life years for women in resource limited lands. From the nursing perspective health promotion and disease prevention services are at the core of quality driven and evidence-based health care. And technology must be used to advance quality of life and increase productive life years. As a nurse and women’s health care nurse practitioner I have found no where that no where is this perspective needed more than in the arena of primary and secondary prevention of cervical cancer. CERVICAL CANCER is an important area of action for any cancer control program because of the burden of disease, and the potential for effective prevention via screening. In my 25 or more years in women’s health I have seen great strides made in the area of women’s health care; several new contraceptive methods have emerged, standards and protocols have been revised to reflect more of a focus on health rather than a curative only focus. I must say that although there has been progress made regarding the incidence and prevalence of Cervical Ca and that progress has primarily occurred in United States and Western Europe while the burden of cervical cancer continues to impact quality of life and life years for women in resource limited lands.

Slide 2:Cervical Cancer Incidence & Prevalence

United States 11, 999 cases of cervical cancer 3, 924 deaths (CDC,2005) India Most common form of cancer 25% of all cancers 130,000 cases 74, 000 deaths ( Indiawest.com 2009) This slide highlights the disparity between cervical ca rates in US and countries like India. Around the world nearly there are 500, 000 new cases annually and cervical cancer claims the lives of nearly 300,000 women every year. Four out of five of these deaths occur in developing countries. This slide highlights the disparity between cervical ca rates in US and countries like India. Around the world nearly there are 500, 000 new cases annually and cervical cancer claims the lives of nearly 300,000 women every year. Four out of five of these deaths occur in developing countries.

Slide 3:Cervical Cancer Incidence & Prevalence

Kenya Most common cancer 2635 cases of cervical cancer 2111 deaths (WHO & Institut Català d’Oncologia 2007) Cervical cancer burden is particularly high on the African Continent In Kenya for example there are approximately 9.82 million women aged 15 and older Why the big difference between countries like India, Kenya, and the US? The key difference is in secondary prevention methods … screening. The morbidity and mortality rates are due to a lack of adequate screening and treatment of pre-cancerous lesions. 6 of 10 cervical cancers occur in women who have never received a Pap test or have not been tested in the past five years.Cervical cancer burden is particularly high on the African Continent In Kenya for example there are approximately 9.82 million women aged 15 and older Why the big difference between countries like India, Kenya, and the US? The key difference is in secondary prevention methods … screening. The morbidity and mortality rates are due to a lack of adequate screening and treatment of pre-cancerous lesions. 6 of 10 cervical cancers occur in women who have never received a Pap test or have not been tested in the past five years.

Slide 4:Cervical Cancer Screening & Testing

Pap Smears HPV DNA Colposcopy Treatment of lesions Based on solid evidence, regular screening of appropriate women for cervical cancer with the Papanicolaou (Pap) test reduces mortality from cervical cancer. Cervical cytology screening is effective when started within 3 years after first vaginal intercourse. 2003 hybrid capture 2 HPV DNA testing introduced offered with pap for women over age 30 or used as triage strategy for women with very low grade lesions or ASCUS (atypia of unknown significance This is not feasible in all countries Clinicians that are well trained in sampling technique Laboratories with adequate supplies and cytotechnologists find technological solutions (screening methods that are cheaper, that do not require laboratory back-up, or that allow immediate treatment, with low technology and low-cost treatment options)Based on solid evidence, regular screening of appropriate women for cervical cancer with the Papanicolaou (Pap) test reduces mortality from cervical cancer. Cervical cytology screening is effective when started within 3 years after first vaginal intercourse. 2003 hybrid capture 2 HPV DNA testing introduced offered with pap for women over age 30 or used as triage strategy for women with very low grade lesions or ASCUS (atypia of unknown significance This is not feasible in all countries Clinicians that are well trained in sampling technique Laboratories with adequate supplies and cytotechnologists find technological solutions (screening methods that are cheaper, that do not require laboratory back-up, or that allow immediate treatment, with low technology and low-cost treatment options)

Slide 5:Cervical Cancer Screening & Testing

HIV Infrastructure Workforce Supplies Laboratory facilities Screening is difficult to achieve in Africa partly because of significant competing, urgent health-care needs, in particular the HIV panpidemic, and partly because of poorly functioning health-care delivery systems. Providers in these countries are faced with technical, human resource and financial constraints Human resource capacity continues to be affected by brain drain of There are many types of health care professionals that will require training: • The smear-takers (primary care practitioners or nurses). These individuals must be technically competent • The smear readers (up to the level of cytotechnologists). • Cytopathologists. • Histopathologists. • Colposcopists. • Gynaecologists. • Programme managers for these cancer screening programs Efficient and high quality lab servicesScreening is difficult to achieve in Africa partly because of significant competing, urgent health-care needs, in particular the HIV panpidemic, and partly because of poorly functioning health-care delivery systems. Providers in these countries are faced with technical, human resource and financial constraints Human resource capacity continues to be affected by brain drain of There are many types of health care professionals that will require training: • The smear-takers (primary care practitioners or nurses). These individuals must be technically competent • The smear readers (up to the level of cytotechnologists). • Cytopathologists. • Histopathologists. • Colposcopists. • Gynaecologists. • Programme managers for these cancer screening programs Efficient and high quality lab services

Slide 6:Machakos District Hospital

Machakos District Hospital Regional referral center for Eastern Province 150,000 Primarily farms high ground I liked to use Machakos Kenya as an exemplar for a setting where alternative methods of cervical cancer screening are being used. Machakos is a town in Kenya, 64 kilometres southeast of Nairobi. I liked to use Machakos Kenya as an exemplar for a setting where alternative methods of cervical cancer screening are being used. Machakos is a town in Kenya, 64 kilometres southeast of Nairobi.