Cervical intraepithelial neoplasia (CIN) is a premalignant lesion that may exist at any one of three stages: CIN1, CIN2, or CIN3. If left untreated, CIN2 or CIN3 (collectively referred to as CIN2+) can progress to
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cervical cancer. Instead of screening and diagnosis by the standard sequence of cytology, colposcopy, biopsy, and histological confirmation of CIN, an alternative method is to use a ‘screen-and-treat’ approach in which the treatment decision is based on a screening test and treatment is provided soon or, ideally, immediately after a positive screening test. This guideline provides recommendations for strategies for a screen-and-treat programme
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Prepared as an outcome of ICMR Subcommittee on Cancer Cervix | This consensus document on management of cervix cancer summarizes the modalities of treatment including the site-specific anti-
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cancer therapies, supportive and palliative care and molecular markers and research questions. It also interweaves clinical, biochemical and epidemiological studies.
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Manual for Training in Cancer Control
Globally, 311,000 women die of cervical cancer every year, 85 percent of them
in resource limited regions of the world. To address this grave threat to women,
the WHO made a call to action in 2018
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, resulting in accelerated plans to improve
cervical cancer control under the elimination threshold with respect to cervical
cancer incidence. As part of WHO’s approach to cervical cancer control, availability of high quality,
affordable medical devices for HPV screening, and treatment of precancerous
lesions in low resource settings is indispensable.
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Cancer centres are a major resource in ensuring a comprehensive approach to cancer treatment and its planning. As part of a new roadmap developed by WHO and IAEA to help countries design national
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cancer control programmes, this publication proposes a framework to develop a cancer centre and/or to strengthen the provision of services in an existing cancer centre. The publication provides the features of multidisciplinary cancer care and details the infrastructure, human resources and equipment for different services. This framework is expected to be used as a guide to implementation, taking into consideration the local context and resources.
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The key areas covered are diagnosis, imaging, pathology, surgery, rehabilitation, palliative care and survivorship. It emphasizes a multi-disciplinary team approach which is paramount for quality cancer care. The specific cancers co
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vered are breast, central nervous system, gastrointestinal, gynecological, head and neck, hematological, Kaposi’s sarcoma, lung, prostate and pediatric cancers. They also complement the National Guidelines for Cancer Management in Kenya released in 2013.
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Le cancer du col de l’utérus et le cancer du sein constituent de véritables problèmes de santé publique en raison de leur fréquence. A titre d'exemple, environ 275 000 femmes meurent chaque a
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nnée d’un cancer du col de l’utérus dans le monde et la plupart de ces décès surviennent dans des pays à revenu faible (90%) car le diagnostic est souvent fait à des stades avancés de la maladie.
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It is estimated that more than 311 000 women die of cervical
cancer each year. Of these deaths, 91% occur in low- and
middle-income countries. Demographic changes and a lack of
action mean that t
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he number of deaths per year is projected
to reach 460 000 by 2040.
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Guide des pratiques essentielles
The purpose of cancer screening tests is to detect pre-cancer or early-stage cancer in asymptomatic individuals so that timely diagnosis and early
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treatment can be offered, where this treatment can lead to better outcomes for some people.
The aim of a cancer screening programme is either to reduce mortality and morbidity in a population by early detection and early treatment of a cancer (for example, breast screening) or to reduce the incidence of a cancer by identifying and treating its precursors (such as cervical and colorectal screening).
This short guide is designed to be a quick reference that contains the important ideas about cancer screening. Readers should refer to other publications for comprehensive discussion and detailed guidance on cancer screening programmes.
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To identify and to assess factors enhancing or hindering the delivery of breast and cervical cancer screening services in Malawi with regard to accessibility, uptake, acceptability and effectiveness
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Systematic review of published scientific evidence. A search of six bibliographic databases and grey literature was executed to identify relevant studies conducted in Malawi in the English language, with no time or study design restrictions. Data extraction was conducted in Excel and evidence synthesis followed a thematic analysis approach to identify and compare emerging themes.
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Background: Cervical cancer accounts for 23% of cancer incidence and 22% of cancer mortality amo
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ng women in Burkina Faso. These proportions are more than 2 and 5 times higher than those of developed countries, respectively. Before 2010, cervical cancer prevention (CECAP) services in Burkina Faso were limited to temporary screening campaigns.
Program Description: Between September 2010 and August 2014, program implementers collaborated with the Ministry of Health and professional associations to implement a CECAP program focused on coupling visual inspection with acetic acid (VIA) for screening with same-day cryotherapy treatment for eligible women in 14 facilities. Women with larger lesions or lesions suspect for cancer were referred for loop electrosurgical excision procedure (LEEP). The program trained providers, raised awareness through demand generation activities, and strengthened monitoring capacity.
Methods: Data on program activities, service provision, and programmatic lessons were analyzed. Three data collection tools, an individual client form, a client registry, and a monthly summary sheet, were used to track 3 key CECAP service indicators: number of women screened using VIA, proportion of women who screened VIA positive, and proportion of women screening VIA positive who received same-day cryotherapy.
Results: Over 4 years, the program screened 13,999 women for cervical cancer using VIA; 8.9% screened positive; and 65.9% received cryotherapy in a single visit. The proportion receiving cryotherapy on the same day started at a high of 82% to 93% when services were provided free of charge, but dropped to 51% when a user fee of $10 was applied to cover the cost of supplies. After reducing the fee to $4 in November 2012, the proportion increased again to 78%. Implementation challenges included difficulties tracking referred patients, stock-outs of key supplies, difficulties with machine maintenance, and prohibitive user fees. Providers were trained to independently monitor services, identify gaps, and take corrective actions.
Conclusions: Following dissemination of the results that demonstrated the acceptability and feasibility of the CECAP program, the Burkina Faso Ministry of Health included CECAP services in its minimum service delivery package in 2016. Essential components for such programs include provider training on VIA, cryotherapy, and LEEP; provider and patient demand generation; local equipment maintenance; consistent supply stocks; referral system for LEEP; non-prohibitive fees; and a monitoring data collection system.
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This WHO Guidance Note advocates for a comprehensive approach to cervical cancer prevention and control and is aimed at senior policy makers and programme managers. It describes the need to deliver
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effective interventions across the female life course from childhood through to adulthood. These include community education, social mobilization, HPV vaccination, screening, treatment and palliative care. It outlines the complementary strategies for comprehensive cervical cancer prevention and control, and highlights collaboration across national health programmes (particularly immunization, reproductive health, cancer control and adolescent health), organizations and partners.
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This publication is based on the list of clinical interventions selected from clinical guidelines on prevention, screening, diagnosis, treatment, palliative care, monitoring and end of life care. This publication addresses medical devices for six types of
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cancer: breast, cervical, colorectal, leukemia, lung and prostate. The first section defines the global increase in cancer cases, the global goals to manage NCDs and the WHO activities related to these goals. The second section presents the methodology used for the selection of medical devices that support clinical interventions required to screen, diagnose, treat and monitor cancer stages, as well as the provision of palliative care, based on evidence-based information. The third section lists the priority medical devices required to manage cancer in seven different units of health care services: 1. Vaccination, clinical assessment and endoscopy, 2. Medical imaging and nuclear medicine, 3. Surgery, 4. Laboratory and pathology, 5. Radiotherapy, 6. Systemic therapy and 7. Palliative and end of life care
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Human Papilloma Virus (HPV) is the most common sexually transmitted infection, and two types of HPV (16 and 18) cause nearly 50% of high-grade cervical pre-cancers. HIV and cervical
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cancer are inextricably linked. Women living with HIV are six times more likely to develop cervical cancer, which is one of the AIDS-defining illnesses and the most common cancer among women living with HIV globally. Cervical cancer is a preventable, curable disease and can be eliminated as a public health problem with primary and secondary prevention, treatment, and care of cervical cancer, in combination with addressing social, health and other inequalities and integrated approaches.
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Prepared as an outcome of ICMR Subcommittee on Buccal Mucosa Cancer | This consensus document on management of Buccal Mucosa cancers summarizes the modalities of treatment including the site-specific anti-
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cancer therapies, supportive and palliative care and molecular markers and research questions. It also interweaves clinical, biochemical and epidemiological studies.
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