Cervical Cancer Prevention Project AAWC

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Cervical Cancer Prevention Project AAWC

• Lilit Hakobyan
• Gynecologist
• Yerevan, Armenia
• Lead Investigator

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Project Funding

• This project was made possible through a grant
  funded by PATH
• Project duration 18 months

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Armenian-American Wellness Center

• Established 1997
• Mammography Center
• Expansion
• Gynecology service 2001
• Primary Health Care 2003
• Two regional branches

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Demography Armenia
Population 3,212, 200 Yerevan 1,101,900 Women
589,942 Population of 10 marz 2,110,300 Women 1,
081,070
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Project Goal

• Establish Pap-smear services in all 11 regions
  of Armenia
• Treatment of cervical dysplasia
• Increase awareness of cancer prevention
• - among doctors
• - among population

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Project Activities

• Identify screening target groups
• Raise public awareness
• Training for nurses in each region
• Organize screening rooms
• Patient examination by AAWC gynecologist and
  radiologist
• Preparation of pap-smears
• Patient follow-up treatment

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Screening Target Groups

• Low-income women age 30-65 who have never had
  pap-tests, or during last 10 years
• Women age 20-30 with cervical lesions such as
  erosion

• Identification of poor population groups
• Regional social services
• Community organizations
• Refugees

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Raising Public Awareness

• Information for patients
• TV
• Booklets
• Lectures in Wellness Center and Marzes
• We can prevent cervical cancer
• What is Pap-test
• What is colposkopy
• What is Leep

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Education Doctors,Nurses, and Students

• Nurses Training program
• Theoretic lecture course
• Practice in center

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Organizing Screening Rooms

• In hospitals, policlinics in each district
• We use disposable speculums, Pap-packs

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Patient Examination

• Perform pelvic examine
• Perform breast exam
• Treat any identified infection
• Promote healthy live-style advice

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Observation Visits

• According to schedule up to 60 of screening
  group was examined by gynecologist and
  radiologist from AAWC
• Refresher training as needed (poor quality of
  smears)
• Treatment of STD cases

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Advantages

• Patients were screened for breast cancer and
  cervical cancer
• Patients can be examined locally
• Patients and their sexual partners received STI
  treatment
• Pap-smear quality control was done in
• the US

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Problems

• Patients have to visit center twice for
  colposcopy and biopsy, and then for LEEP
• One patient refused treatment

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2
4
2
2
1
0
1
2
2
2
2
Screening Results of dysplasia
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Summary

• Dysplasia occurred in 2
• Highest of dysplasia is diagnosed in Tavush
  marz
• All cases of dysplasia were treated by LEEP after
  colposcopy and histological exam
• A patient with invasive cases had treatment in
  the oncology center
• 25-28 of women had STDs

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Conclusions and Lessons Learned

• Colposcopy and biopsy should be available for
  people locally
• RH programs should be implemented regularly
• It is necessary to establish diagnostic system
  for onco-type HPV, typical for Armenian
  population