There is a high burden of HPV infection in women coming to the antenatal clinic of a referral hospital I mentor. Since I do clinical consultation of HIV and STI related cases they usually keep them for me to see. However we could not provide screening services for CIN and we know that HPV contributes to 90% of cervical ca cases. However we do not provide screening services which means we could not offer the opportunity of treating early cases of CIN thereby preventing advanced ca. Recently I took an online course and exam which I passed on VIA (visual inspection of the cervix using aceton) and the screening involves treating of suspicious cases using cryo therapy which I also could administer. cryotherapy is highly effective and well tolerated. So my question here is that if there is anyone here willing and able to assist me to set up the screening and early treatment as well as prevention of advanced ca of the service in this resource poor setting. Thank you.
Cevicovaginal cytology is undoubtedly the best method for carcinoma of cervix screening in poor setting.There are pros and cons of the method ,but in poor setting its the good method then VIA-visual inspection of acetowhite areas and the there is invasive procedure as biopsy from lesion.there are false positive and false negative results also by VIA. SO PAP is preferred in many ways....And my personal experience was shared on papsociety.org...in,,,Viewpoint: Cytology-Based
Screening in India . . . . . . . . . . .14.link
Dec 2011 - Papanicolaou Society of Cytopathology
www.papsociety.org/.../FOCUS%20December%202011(FINAL12-13-20.....
In our hospital we have a department of preventing oncology in gynaecology.am a Faculty in training the doctors in colposcopy course.in developing countries as we are still getting the most of the cases in advanced stages of gynaecological malingnancies in carcinoma of ovary and carcinoma cervix.on the mass screening VIA,visual inspection of cervix and application of Acetic acid to see Acetowhite area is one of the method in Downstaging of cancer screening programs by trained paramedical workers.pap smear is the routine screening method from the age of 25 years in institutional practice.in high risk cases and indicated cases we are performing colposcopy and guided biopsy of the cervix.Liquid base cytology is one of the recent technology in cytopathology.HPV-DNA testing is done in indicated cases and helps in the management.in early cases of CIN we can go ahead as Cryocoagulation,LLETZ,CONIZATION.rest advanced cases treated according the FIGO staging.thank you
I think that the best way is combination of PAP smear (ecto- and endo-cervical) and Colposcopy.
Dear Naira I really appreciate your assistance and I want to thank you. It is an interesting information that you just told me. Can I have an email of the person you mentioned or anything that can lead me to him. Thank you a lot.
If your program is in Missouri, and affiliated with the University, you will have some additional problems that have nothing to do with medicine or finance. Your program has to be consistent with the Missouri standard of care, or you and your institution may be subject to a malpractice lawsuit.
If I were establishing a program such as you are contemplating in a poor venue with no medicolegal considerations, I'd use VIA to identify patients for colposcopy, and would perform cryotherapy based on benign- appearing colposcopy with satisfactory visualization of the transformation zone (or not, depending on whether the system could afford the cost of reading the histopathology on the occasional endocervical curettage).
But having practiced in St. Louis, Missouri for 7 years in the 1980's, and having seen the medicolegal climate there and outtate, I'd be reluctant to do anything like that without talking to my institution's risk management department. The same goes for any diagnostic test not approved by the FDA.
Thank you very much Allan and to answer your question I am not based in Missouri I am practicing in East Africa Ethiopia and there will be no medico legal issues that could hinder the program for there are no other options. But thank you
You're welcome. Your tag says "University of Missouri," which is why I posted what I did.
Okay I think that was because I registered to the site using my university account but still it was Columbia University I don't know where Missouri came up. I will have to edit if I can. Thank you again.
In a low resources Country like yours ,I think HPV HR test is the best sceening method because it has a virtually 99% negative predictive value :
management :negative cases ok,repeat screening after five years ; HPV positive cases perform colposcopy and eventually see and treat procedure by criotherapy.
Besides that ,a vaccination program for HPV should be implemented for primary prevention .
Thank you for the input it is quite valuable however most programs in our set up are started or run by donors who have their own priorities and the service I mentioned does not exist due to the very fact that the local problems could only be prioritized deliberately only if there are locally available resources or if someone like me had a chance encounter of people who can support it.
You can try using the Visual Inspection of acetic acid (VIA ) method. it is cheaper and easy to perform in a resource limited setting.
- Badges
- Science topic
- Similar topics
- Human-Computer Interaction
- Collaboration