Cervical cancer library

Screening and treatment

Featured resources

10 Key Findings and Recommendations for Effective Cervical Cancer Screening and Treatment Programs
Alliance for Cervical Cancer Prevention (ACCP)
In early 2007, the ACCP partners met to assess newly-analyzed results of key studies in India, South Africa, Peru, and Thailand. These new data spurred the partners to outline ten key findings and recommendations for global policy and practice related to cervical cancer screening and treatment in low-resource settings.

ACCP member journal articles on cervical cancer screening and treatment
ACCP
This listing includes findings from more than 20 ACCP demonstration and research projects, offering important insights into the potential effectiveness of different screening and treatment strategies under a range of conditions.

Alliance for Cervical Cancer Prevention: Shifting the Paradigm (2005)
International Journal of Gynecology and Obstetrics. 2005;89(S2).
This nine-article supplement addresses issues relevant to training staff to prevent cervical cancer in low-resource settings.

Cervical cancer page
International Agency for Research on Cancer (IARC)
This page features numerous training and research resources that explore the accuracy, reproducibility, efficacy, benefits, harmful effects, and cost-effectiveness of screening interventions for cervical cancer.

Cervical Cancer Prevention in Peru: Lessons Learned from the TATI Demonstration Project (2006)
Luciani S, Winkler J
Through collaboration of the Peru Ministry of Health, Pan American Health Organization, and PATH, the TATI (acronym for the Spanish term, tamizaje y tratamiento inmediato) demonstration project investigated methods that could improve the effectiveness of the cervical cancer screening program in the region of San Martín, Peru. This report summarizes the methods, results, and lessons learned from the TATI project.

Colposcopy and Treatment of Cervical Intraepithelial Neoplasia: A Beginner’s Manual (2003)
Sellors J, Sankaranarayanan R, IARC.
This online manual is designed to equip health care providers with the necessary skills to detect and treat cervical intraepithelial neoplasia, thereby preventing invasive cervical cancer in many women worldwide.

Comprehensive Cervical Cancer Control: A guide to essential practice (2006)
World Health Organization (WHO)
This publication is designed to provide comprehensive practical advice to health care providers at all levels of the health care system on how to prevent, detect early, treat, and palliate cervical cancer.

Conclusions From ACCP Clinical Research in Developing Countries (2004)
ACCP
ACCP projects have focused on regions in which cervical cancer incidence and mortality are highest—sub-Saharan Africa, Latin America, and South Asia—and on reaching women in their 30s and 40s, since many women in these regions may be screened only once or twice in their lifetimes.

COPE for Cervical Cancer Prevention Services: A Toolbook to Accompany the COPE Handbook® (2004)
EngenderHealth
COPE, which stands for "client-oriented, provider-efficient" services, is a process that involves facility staff and supervisors to jointly assess services in order to improve quality. This toolbook includes guides, checklists, and forms to help those in settings where resources are highly restricted to integrate the various elements of service provision into a comprehensive and quality whole.

Course in Visual Methods for Cervical Cancer Screening: Visual Inspection with Acetic Acid and Lugol's Iodine (2004)
PATH
This manual is designed for trainers of clinicians who perform vaginal speculum
examination and screening methods to prevent cervical cancer. Please note that the online version below is a preview. The complete CD-ROM may be ordered by emailing rho@path.org.

Evidence-Based, Alternative Cervical Cancer Screening Approaches in Low-Resource Settings (2009)
Sherris J, Wittet S, Kleine A, et al. International Perspectives on Sexual and Reproductive Health. 2009;35(3)147-152.
On the basis of new data and the results of earlier research conducted in 20 African, Asian and Latin American countries, the ACCP partners summarize and share key findings and recommendations for effective cervical cancer screening and treatment programs in low-resource settings in this 6-page article.

Global Guidance for Cervical Cancer Prevention and Control (2009)
International Federation of Gynecology and Obstetrics (FIGO)
This guidance is intended as a focused update on cervical cancer prevention, screening and treatment strategies. It is intended to be complimentary to the World Health Organization's Comprehensive Cervical Cancer Control: A Guide to Essential Practice.

Histopathology of the uterine cervix - digital atlas (2003)
Frappart L., Fontanière B., Lucas E., Sankaranarayanan R. IARC.
This atlas is intended for practicing pathologists, cytotechnologists and technicians. It is also suitable for resident pathologists training in medical schools and for cytology technicians, particularly in developing countries.

HPV Vaccines and Screening in the Prevention of Cervical Cancer (2006)
Bosch F, Cuzick J, Schiller J, Garnett G and Meheus A, Franco E, Wright T, eds. Vaccine. 24(S3):S1–S264.
This 250-page publication provides a convenient summary of the vast literature of over 100 authors' individual areas.

Improved Cervical Cancer Prevention: Planning Now for a Better Future (2010)
PATH, Association of Obstetricians and Gynaecologists of Uganda, Uganda Ministry of Health
This report documents an African regional conference on cervical cancer prevention held in September 2010 in Kampala, Uganda. Representatives from nine African countries met to share updates on cervical cancer vaccination and screening programs, and to plan regional strategies. Participants were from the fields of cancer, reproductive health, immunization, adolescent health and related areas. The report summarizes conference presentations and country discussions on priorities, activities, and needs for technical support.

Improving Screening Coverage Rates of Cervical Cancer Prevention Programs: A Focus on Communities (2004)
Cervical Cancer Prevention Issues in Depth No. 4. ACCP.
This paper describes the community focus taken by ACCP projects in eight countries. Included is an overview of the strategies used to increase screening coverage, and lessons learned about how to meet women’s needs effectively through a community focus.

Effectiveness, Safety and Acceptability of Cryotherapy: A Systematic Literature Review (2003)
Cervical Cancer Prevention Issues in Depth No. 1. ACCP.
This 62-page document is a systematic review of the literature on the use of cryotherapy as an outpatient treatment option for women with cervical intraepithelial neoplasia. The review examines the available data on the effectiveness, safety, and acceptability of cryotherapy.

Glossary of Screening, Diagnosis and Treatment Methods for Cervical Cancer (2004)
Pan American Health Organization
This 4-page document is a glossary of terms specific to screening, stages of cancer, and advanced treatment.

New evidence on the impact of cervical cancer screening and treatment using HPV DNA tests, visual inspection, or cytology (2009)
ACCP
This 3-page fact sheet puts new evidence from India into context and provides guidance relating to investment in visual inspection-based screening programs in low-resource settings. The document seeks to help program managers and decision-makers interpret and use the new data.

New Options for Cervical Cancer Screening and Treatment in Low-Resource Settings (2010)
Cervical Cancer Action
Examines screening in the era of HPV vaccination and provides the latest evidence on new screening and treatment modalities for developing countries.

Outlook. Progress in preventing cervical cancer: Updated evidence on vaccination and screening
Murray M. Outlook. 2010;27(2). PATH.
This 12-page issue of Outlook provides an update on opportunities for preventing cervical cancer through vaccination and screening. It summarizes recent evidence on the safety and efficacy of human papillomavirus vaccines as well as successful approaches for screening and treatment in low-resource areas. Other topics include cost-effectiveness, communication and training, and implications for policy and programs.

Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers (2004)
PATH and ACCP
This publication provides thorough background information on cervical cancer and extensive detail on screening.

A Practical Manual on Visual Screening for Cervical Neoplasia (2003)
Sankaranarayanan R and Wesley R, eds. IARC.
Featuring 80 color photographs, this 49-page manual is intended to help in the training of a range of health-care personnel such as health workers, nurses and physicians to perform visual inspection with acetic acid and visual inspection with Lugol's iodine. Information on ordering printed copies is also available.

PubMed article search: Cervical cancer screening and treatment
National Center for Biotechnology Information (National Library of Medicine and National Institutes of Health)
This predefined search on cervical cancer and HPV screening and treatment contains the latest scientific journal citations and abstracts from the PubMed database.

Recent Evidence on Cervical Cancer Screening in Low-Resource Settings (2011)
ACCP
This fact sheet summarizes recent data on cervical cancer screening approaches for low-resource settings. This summary presents evidence published since ACCP's 2009 article on alternative screening approaches. New evidence continues to support the feasibility and accuracy of screening technologies that are alternatives to resource-intensive Pap smears.

Safety, acceptability, and feasibility of a single-visit approach to cervical-cancer prevention in rural Thailand: a demonstration project (2003)
Gaffikin L, Lauterbach M, Emerson M. The Lancet. 2003;361(9360):814–820.
This evaluation assessed the value of a single visit approach using a combination of visual inspection of the cervix with acetic acid and cryotherapy in a rural area. Although a variety of treatment options exist for use in an outpatient setting, cryotherapy was the treatment of choice for this joint JHPIEGO/Thailand project.

Screening cervical cancer in developing countries. Report of a World Health Organization Consultation (2002)
WHO
This 89-page position paper focuses on cytology screening in middle-income countries with specific recommendations for improving efficacy and effectiveness of programs.

START-UP: Innovation in cervical cancer screening
PATH
The Screening Technologies to Advance Rapid Testing for Cervical Cancer Prevention (START-UP) project was initiated to help introduce low-cost, easy-to-use, and culturally acceptable screening technology and treatment strategies for cervical cancer in low-resource countries.

Visual inspection with acetic acid for cervical-cancer screening: test qualities in a primary-care setting
The Lancet. 1999;353(9156):869–873.
Naked-eye visual inspection of the cervix with acetic acid wash (VIA), or cervicoscopy, is an alternative to cytology in screening for cervical cancer in poorly resourced locations. This study tested the sensitivity, specificity, and predictive value of VIA done by nurse-midwives in a less developed country.

Western Kenya Cervical Cancer Prevention Project Final Report (2004)
ACCP
This 35-page report is from a collaborative project with PATH, the Kenya Ministry of Health, Mandeleo ya Wanawake Organization, and the Kenya Cancer Society to develop and evaluate a model cervical cancer prevention program suitable for rural, low-resource settings in Africa. Appendices are available by contacting rho@path.org.

WHO guidelines: Use of cryotherapy for cervical intraepithelial neoplasia (2011)
WHO
This document summarizes the new evidence-based WHO recommendations about the use of cryotherapy in women with histologically confirmed cervical intraepithelial neoplasia in low-, middle- and high-income countries.

WHO/ICO Information Centre on HPV and Cervical Cancer
WHO and the Institut Català d’Oncologia
This website offers country-specific reports on cervical cancer burden of disease, prevalence of HPV infections, and related factors for cervical disease to evaluate prevention strategies.

WHO HPV Laboratory Network (LabNet)
WHO
LabNet's mission is to contribute to improving quality of laboratory services for effective surveillance and monitoring of HPV vaccination impact through enhanced, state-of-the-art laboratory support.

General screening and treatment resources

Cervical Cancer: Prevention and Early Detection page
American Cancer Society
This page provides complete information about cervical cancer screening, treatment, risk factors, and prevention.

Cervical cancer prevention: safety, acceptability, and feasibility of a single-visit approach in Accra, Ghana.
Blumenthal PD, Gaffikin L, Deganus S, et al. American Journal of Obstetrics and Gynecology. 2007;196(4):407.e1–407.e9.
This study assessed the safety and acceptability of a single-visit approach to cervical cancer prevention combining visual inspection of the cervix with acetic acid wash (VIA) and cryotherapy.

Cervical cancer screening and testing page
National Cancer Institute
Developed for both patients and health professionals, this page provides extensive information about tests used to screen for cervical cancer, as well as how to interpret test results.

Guidelines for cervical cancer screening programme (2005)
Government of India-WHO Collaborative Programme
These guidelines have been developed for population-based cervical cancer screening programmes in India, and can be adapted according to available resources.

Jhpiego technical reports from Ghana and Thailand (2008)
Jhpiego
These operations research studies examined the extent to which the quality of cervical cancer prevention and treatment services was maintained after external funding had been removed in Ghana and Thailand—two countries with Cervical Cancer Prevention (CECAP) programs that had previously
received significant external financial support.

Medline Plus: Cervical cancer
National Library of Medicine and National Institutes of Health
Medline Plus provides listings of cervical cancer resources in the areas of prevention, screening, treatment, and research. The site also includes information about cervical cancer organizations, law, policy, and more. Resources are US-focused, but could be adapted for global contexts.

OncoLink: Cervical cancer
Abramson Cancer Center of the University of Pennsylvania
OncoLink offers a range of information, including an overview of cervical cancer, summaries of recent US meetings on cancer, and examples of provider and client information on Papanicolau (Pap) tests, colposcopy, and dysplasia treatment. The site is intended for a US audience, but much of the information (in particular the client-oriented material) could be adapted for use in other settings.

Visual inspection with acetic acid for cervical cancer screening outside of low-resource settings (2005)
Jeronimo J, Morales O, Horna J, Pariona J, Manrique J, Rubiños J, Takahashi R. Pan American Journal of Public Health / Revista Panamericana de Salud Pública. 2005;17(1):1–5.
This study assessed VIA as a screening tool for use in a well-equipped health center in Peru, evaluated VIA as an alternative or adjunct to the Pap smear, and determined if VIA can play a role in better-resourced settings.