Cervical Cancer Screening

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• Cervical Cancer Screening Testing Appropriate
  Technology for Resource Limited Countries

Kimberly Adams Tufts, DNP, WHNP-BC, FAAN
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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)

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Cervical Cancer Incidence Prevalence

• Kenya
• Most common cancer
• 2635 cases of cervical cancer
• 2111 deaths (WHO Institut Català dOncologia
  2007)

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Cervical Cancer Screening Testing

• Pap Smears
• HPV DNA
• Colposcopy
• Treatment of lesions

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Cervical Cancer Screening Testing

• HIV
• Infrastructure
• Workforce
• Supplies
• Laboratory facilities

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Machakos District Hospital

• Machakos District
• Hospital
• Regional referral center
• for Eastern Province
• 150,000
• Primarily farms high
• ground

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Machakos Approach
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• Integration of screening services into existing
  health services
• Maternal child services
• Train diversity of clinicians
• Engage the community at large

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Cervical Screening Testing

• Visual Inspections with Acetic Acid Application
  (VIA)

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Cervical Cancer Screening Testing

• 2400 women examined using VIA and colposcopy.
  VIA detected abnormalities in 98.4 as confirmed
  by colposcopy (Ottaviano La Torre,1982)
• Study of 145 women attending health clinics, the
  reported odds ration for a positive cytology was
  6.6 if VIA was also positive.
• VIA resulted in an additional 15 of CIN cases
  being identified among cytology negative women
  but 40 of the women with positive VIA underwent
  unnecessary colposcopy due to false positive
  (University of Zimbawe JHPIEGO Cervical Cancer
  Project, 1999)
• VIA detected 65 of high-grade squamous
  intraepethilial lesions (HSIL) confirmed by the
  reference standard (Megevand et al., 1996).

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