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Cervical cancer screening and management of cervical pre-cancers. Training of health staff in colposcopy, LEEP and CKC. Trainees' handbook.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 199 p.The Trainees’ handbook is designed to train gynaecologists and non-specialist clinicians in performing colposcopy and treatment of cervical precancerous conditions so they can provide the necessary diagnostic and therapeutic services in a cervical cancer screening programme. The Trainees’ handbook contains guidelines and information intended to be used both by trainees and facilitators while participating in the structured training programme on cervical cancer screening and treatment. The Trainees’ handbook contains different modules intended to assist trainees to develop their knowledge and learn the correct steps to perform colposcopy and treatment procedures. The modules contain checklists that serve as ready reckoners to develop skills in various procedures during clinical sessions. These checklists are also intended to be used by trainees during their post-training practice. The structure and methodology of the training have been designed to impart knowledge in the most effective manner and have taken into consideration the overall training objectives, profiles of trainees and the expected learning outcomes. (Excerpt)
Cervical cancer screening and management of cervical pre-cancers. Training of health staff in colposcopy, LEEP and CKC. Facilitators' guide.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 118 p.This manual is an instruction guide for facilitators to provide competence based training to providers of colposcopy and treatment services in a cervical cancer screening programme. The training is intended to assist gynaecologists and non-specialist clinicians to learn and improve upon their skills to perform colposcopy and to treat cervical pre-cancers by excision methods. Facilitators are required to consult both the Facilitators’ guide and the Trainees’ handbook while training participants through interactive presentations, group discussions, role plays, clinical practice sessions, etc. The Facilitators’ guide contains detailed training methodologies, structure of the individual training sessions and guidelines for assessment of trainees. The Trainees’ handbook contains different modules to assist trainees with step-by-step learning of colposcopy and treatment procedures. (Excerpt)
Prevention of tuberculosis in children. Detection and chemotherapy of infectious cases of tuberculosis.
CHILDREN IN THE TROPICS. 1992; (196-197):60-9.Prevention of tuberculosis (TB) in children in developing countries involves 3 interventions: detection and treatment of sources of infection, i.e., adults with pulmonary TB; BCG vaccination of newborns to prevent primary infection and its complications; and prophylactic treatment of newly infected infants. The first element of prevention is reviewed here. In less developed areas, detection and diagnosis of TB entails education of the public and of health providers so that people with chronic cough have sputum sent to regional laboratories for microscopic examination. Rarely, x-ray facilities may also be used. Quality control of laboratory work and universal coverage are essential. The proportion of actual cases of TB diagnosed by microscopy ranges from 5 to 10% in African and Latin American countries to 25% in Asian countries, depending on the prevalence of TB, the age structure of the population, and the quality of the laboratories. Calculated rates of detection are 60-90% however. There are 3 types of infectious TB cases; new cases with smear-positive pulmonary TB (80-90%), previously treated cases who are true or false failures or relapses, and chronic TB cases who probably have resistant organisms. In developing countries, the last group will probably not receive second-line drugs because of the cost, but will be treated with isoniazid alone and are considered unlikely to recover. At the end of standardized treatment, there are 6 classes of patients: cured cases, probable cures, failures or relapses, decreased, lost to follow-up, and move to another district for care. World Health Organization objectives for rate of cure will probably be modified in given countries due to financial limitations.
The WHO Collaborative Study of Neoplasia and Steroid Contraceptives: the influence of combined oral contraceptives on risk of neoplasms in developing and developed countries.
CONTRACEPTION. 1991 Jun; 43(6):695-710.A hospital-based case-control study was conducted in 8 developing and 3 developed countries to determine whether use of combined oral contraceptives (OCs) alters risks of various cancers. An observed trend of increasing risk of invasive cervical cancer with duration of use may not represent a causal relationship and is the subject of further study. Decreased risks of ovarian and endometrial carcinomas in users likely indicate a protective effect of OCs, the degree of which was similar in developing and developed countries. A small increase in risk of breast cancer in recent and current users was found to be somewhat greater in developing countries. Both causal and noncausal interpretations of this finding have been offered. No associations were found between OCs and in situ cervical, hepatocellular, cholangio, or gallbladder carcinomas, or uterine sarcomas. However, the ability of this study to detect alterations in risks for these neoplasms in longterm users was low. (author's)
Histologic types of breast carcinoma in relation to international variation and breast cancer risk factors. WHO Collaborative Study of Neoplasia and Steroid Contraceptives.
INTERNATIONAL JOURNAL OF CANCER. 1989 Sep 15; 44(3):399-409.Associations between breast cancer risk factors and histologic types of invasive breast carcinoma were studied in 2728 patients. Lobular and tubular carcinomas occurred with increased relative frequency in most high risk groups. The proportion of these types increased with age to a maximum at 45-49 years and decreased in the following decade. Significantly increased proportions of lobular and tubular carcinomas were also associated with high risk countries, prior benign breast biopsy, bilateral breast cancer, concurrent mammary dysplasia, high age at 1st livebirth, never-pregnant patients compared to those with a 1st livebirth before age 20, private pay status, and length of education. Nonsignificant increases were associated with family history of breast cancer, less than 5 livebirths, less than 25 months total breastfeeding, use of oral contraceptives or IUD, and high occupational class. As a general trend, the higher the overall relative risk, the higher the proportion of lobular and tubular carcinomas. The occurrence of other histologic types also increased breast cancer risk, but to a smaller degree than for lobular/tubular carcinomas. It is suggested that all hormonally related, socioeconomic, and geographic risk factors enter their effect by selectively increasing the number of lobular cells at risk. Family history of breast cancer and age over 49 years did not follow the general trend of parallel increases in the proportion of lobular/tubular carcinomas and breast cancer risk, and may operate through other mechanisms. (author's)
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1987; 65(6):817-27.Cervical cancer ranks as the 2nd most frequent cause of cancer in women. Research demonstrates that infection with the human papilloma virus (HPV) leads to cervical cancer. The clinical HPV lesion in both sexes is the pointed wart like tumor called condyloma acuminatum. Detecting subclinical lesions varies, however, based on the genital organ and on the methods of examination. Several types of HPV infect anogenital epithelia and the resultant disease is partially determined by HPV type. In vitro methods to detect HPV do not exist, so laboratory personnel must depend on biochemical diagnostic procedures--molecular hybridization and serological procedures. HPV lesions, especially HPV- 16 and HPV-18, may turn into carcinomas depending on the activation or inactivation of some unknown genes perhaps influenced by tobacco smoking, oral contraceptives, other genital infections, or other unknown cofactors. Clinicians need to realize the potential gravity of HPV infection including the pathogenesis of lesions and its transmission through sexual contact. They must also be able to perform those diagnostic procedures that can detect HPV infection. Treatment of HPV lesions (e.g., cryosurgery, cautery, etc.) aims to either cure a repulsive, infectious, yet uncomplicated condition or prevent invasive cancer if HPV is connected with intraepithelial neoplasia. The results of the few well controlled studies of treatment of anogenital HPV- induced lesions show that 15-60% of lesions return with 3 months of treatment. Researchers must discover if humoral immunity can protect against HPV infection, and if it can, a vaccine using purified structural proteins should quickly be developed and approved.
A retrospective analysis of family planning Papanicolaou smear data: lessons for the future. 2. Planned Parenthood's national experience, 1975.
Advances in Planned Parenthood. 1978; 12(3):144-148.In 1975, 96,254 Papanicolaou smears were submitted by Planned Parenthood clinics in 9 of the 10 Health, Education, and Welfare regions to a single laboratory. Smears were interpreted and classified as I (negative), II (negative, benign reactive changes), II+ (minimal dysplasia), IIIA (mild dysplasia), III (moderate dysplasia), III+ (moderate to severe dysplasia), IV (severe dysplasia and/or carcinoma in situ), V (invasive carcinoma), or 0 (inadequate for evaluation). Of the 95,907 smears suitable for cytologic evaluation, 4572 (5.3%) showed evidence of dysplastic or neoplastic changes. Histopathologic specimens were obtained for 242 women with abnormal cervical cytology. Mild to moderate dysplasia was noted in 86 (35.5%), severe dysplasia in 34 (14%), carcinoma in situ in 54 (22.3%), and invasive cancer in 4 (1.7%). 64 (27.2%) tissue specimens proved to be normal. 75% of smears demonstrating at least moderate dysplasia were obtained from women under 25. Since the pap smear is only a screening procedure, abnormalities detected by this method require diagnostic confirmation and follow-up. The low response rate of local affiliates to laboratory requests for information on cytology/histology correlates of their patients makes it impossible to determine if this was provided. In addition, the "false negative" rate of the pap smear screening program could not be determined as biopsies were not obtained for women with Class I or II smears. While lessening clinic autonomy, the standardization of medically relevant protocols for follow-up and computerized methods of data collection would increase factual information and knowledge of the cost-effectiveness of services provided.