scholarly journals Precision Prevention: The 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors

2021 ◽  
Vol 2 (3) ◽  
pp. 274-280
Author(s):  
Ritu Nayar

The approach to cervical cancer prevention has evolved significantly over the past two decades. HPV immunization has decreased the specificity of screening modalities and HPV-based testing has been replacing our previously successful morphology-only approach. Additionally, there is much more emphasis on providing precision prevention, rather than the previously used “one-fits-all” management strategies. A number of new biomarkers are entering clinical practice and being integrated into cervical cancer screening and management in order to enable a more personalized assessment of the risk for precancer/cancer for an individual patient. The 2019 ASCCP Risk-Based Management Consensus Guidelines expand on the concept of “equal management for equal risk”. They consider a patient’s history in addition to current test results to provide recommendations for increased surveillance/treatment in patients at higher risk for CIN3+ while minimizing interventions for lower-risk patients who have new versus persistent HPV infection. Clinical management decisions are based on immediate risk and 5-year risk estimates for CIN3+, which are determined by referencing an extensive risk table compiled by the National Cancer Institute (NCI). The course of action for a given patient is recommended by comparison of the risk in the risk database, to the predetermined clinical action thresholds. These guidelines address the need for simplification and offer some stability for the provider while being conducive to the incorporation of anticipated continued technologic advances in methods for cervical cancer prevention. Their enduring nature will allow for changes needed based on risk reduction as HPV vaccination uptake increases and vaccinated women reach screening age. Similarly, the design allows for the addition of new tests into the risk assessment calculations after their approval by applicable regulatory agencies and review/consensus approval by the ASCCP new technology and enduring guidelines workgroups. As cytopathologists, we must be familiar with the scientific advancements in primary and secondary prevention, evolving screening and management guidelines, and participate actively in the multidisciplinary approach for the prevention of cervical cancer.

2020 ◽  
Author(s):  
Oscar Tapera ◽  
Anna M Nyakabau ◽  
Ndabaningi Simango ◽  
Bothwell T Guzha ◽  
Shamiso Jombo-Nyakuwa ◽  
...  

Abstract Background Cervical cancer is the fourth most common cancer amongst women globally and it accounts for many cancer deaths among females in Zimbabwe. The objective of this midterm review was to measure the progress of cervical cancer prevention and control interventions in Zimbabwe. Methods A mixed methods approach was used for the midterm review. Secondary data was collected from programme documents, published and grey literature. Primary data was collected in six provinces, including Harare Metropolitan. Key informant interviews were conducted with officials from relevant departments in the Ministry of Health and Child Care (MoHCC) and partners working in cervical cancer spaces. Two focus group discussions with beneficiaries were facilitated in Manicaland and Matabeleland South Provinces. After data analysis, a draft report was presented to a technical working group to validate the findings and to fill in any gaps. Results The cervical cancer strategy led to the raising of awareness especially around cervical cancer screening and this created demand for services. Coverage of HPV vaccination achieved by 2019 was 86% against a target of 80%. Every district in Zimbabwe had a screening site with a total of 106 clinics across the whole country. Almost two thirds (66%) of women with precancerous lesions received treatment in 2018 against a target of 80%. Tertiary hospitals are offering surgery to eligible women with cervical cancer and there are ongoing efforts towards establishing two centres of excellence in the country. There are opportunities for collaborative, coordinated comprehensive cervical cancer care and research at institutions (public and academic) that can be strengthened and better coordinated by MoHCC. Successes scored in fundraising for ZCCPCS strategy thematic areas including awareness, cervical cancer screening and HPV vaccination set the pace for comprehensive inclusion of diagnosis, treatment and palliative care. Conclusions This midterm review revealed a myriad of gaps of the strategy particularly in diagnosis, treatment and care of cervical cancer and the primary focus was on secondary prevention. Lessons learnt reveals that development and implementation of the next strategy will require increased stakeholder collaboration between government, private sector, academia and non-governmental organizations for more sustainable cervical cancer interventions.


2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Sunday Joseph Ayamolowo ◽  
Lydia Feyisayo Akinrinde ◽  
Monisola Omoyeni Oginni ◽  
Love Bukola Ayamolowo

The global incidence of cancer is rising, and low-income and lower-middle-income countries have the worst figures. However, knowledge of cervical cancer prevention and cervical cancer screening practices remains poor in these regions. This study assessed the concept of health literacy as a potential determinant of knowledge of cervical cancer prevention and screening practices among female undergraduates. A descriptive cross-sectional study was conducted among 385 female undergraduates at a university in southwest Nigeria. A validated questionnaire composed of subscales on nine components of health literacy, knowledge of cervical cancer prevention, and cervical cancer screening practices was used for data collection. The majority of the respondents obtained a high score on most of the components of health literacy and 66% had good knowledge of cervical cancer prevention. Only 11% demonstrated good practices of Pap smear testing. Of all the components of health literacy, “feeling understood and supported by healthcare providers” (OR = 0.075; 95% CI [0.036–0.115]; p = 0.015) and “understanding health information well enough to know what to do” (OR = 0.055; 95% CI [0.006–0.104]; p = 0.029) were significantly associated with knowledge of cervical cancer prevention. Out of the major challenges related to cervical cancer screening among undergraduates, the feeling of being at risk (OR = 4.71; p < 0.05) and uncomfortable experiences from past screening (OR = 0.12; p < 0.05) were significantly associated with going for cervical cancer screening. The study concluded that levels of health literacy influenced knowledge of cervical cancer prevention among female undergraduates, but it did not affect their engagement in cervical cancer screening practices.


Viruses ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 729 ◽  
Author(s):  
Andreas Chrysostomou ◽  
Dora Stylianou ◽  
Anastasia Constantinidou ◽  
Leondios Kostrikis

Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.


2007 ◽  
Vol 197 (4) ◽  
pp. 346-355 ◽  
Author(s):  
Thomas C. Wright ◽  
L. Stewart Massad ◽  
Charles J. Dunton ◽  
Mark Spitzer ◽  
Edward J. Wilkinson ◽  
...  

2017 ◽  
Vol 16 (2) ◽  
pp. 18-22 ◽  
Author(s):  
Andrea Obročníková ◽  
Ľudmila Majerníková

AbstractAim. Cervical cancer is the most common genital malignancy and one of the leading causes of death among female population in Slovakia. At present, this location of cancer is preventable disease visible in screening for premalignant lesions if the women use and participate in such screening regularly. We assessed the knowledge on the cervical cancer screening, the attitude towards it and its utilization among women in Slovakia.Material and methods. A cross-sectional study evaluated the knowledge, attitude and practice of cervical cancer prevention and screening among women. The sample was composed of 239 women aged 18-64 years. Data collection was conducted by selfadministered questionnaire in a period from January to April 2015.Results. Respondents exhibited an average knowledge of cervical cancer, about risk factors and early signs, but awareness of cervical cancer screening was satisfactory. Despite the fact that respondents expressed good attitude to cervical cancer screening, their level of practice was low (64% participation in preventative gynaecology check-ups and 43% in Pap smear tests within one year and 44% within three years). In the study we could observe better results in women with higher education when it comes to an illness (p < .001), its prevention (p < .001) and risk behaviour (p < .001).Conclusions. The awareness of cervical cancer among women in Slovakia is limited. In the future there is a need to educate and promote awareness of cervical cancer among women to reduce the burden of morbidity and mortality.


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