Introduction Different approaches to screening and treatment of cervical precancer Anatomical considerations

Anatomical considerations Gross anatomy of female genital organs, External genitalia Internal genital organs Gross anatomy of the cervix Cervical epithelium Squamous epithelium Columnar epithelium Squamocolumnar junction (SCJ)

Physiological changes of the cervical epithelium

Ectropion Squamous metaplasia Transformation zone of the cervix Changes induced by pregnancy Atrophic changes Congenital transformation zone (CTZ)

Neoplastic changes of the cervical epithelium

Genesis of cervical cancer – Role of HPV HPV structure and types Genesis of precancerous lesions and cervical cancer Cervical intraepithelial neoplasia (CIN) Adenocarcinoma in situ (AIS) Cervical cancers

HPV tests – Variation between tests Instruments, consumables, and setup required

for collection of samples for HPV testing (provider-collected) for self-collection of samples for HPV testing

Procedure to collect samples for HPV testing

Sample collected by a health provider Counselling of a woman undergoing HPV testing History taking Preparation for sample collection for HPV testing Steps for inspection of the external genitalia Steps for insertion of the speculum and exposure of the cervix Steps for collection of cervical samples Steps for self-collection of samples Storage of the samples after collection, and transportation to the laboratory

Interpretation of HPV test results Management of women with a positive HPV test result

Management of women with a positive HPV test result The different strategies Triage with cytology Triage with VIA Triage with colposcopy

Treatment of cervical intraepithelial neoplasia – principles Steps to determine eligibility for ablative treatment

Criteria used to determine eligibility for ablative treatment Steps to determine eligibility for ablative treatment

Role of Lugol’s iodine in identifying the transformation zone for treatment

Role of Lugol’s iodine in identifying the transformation zone for treatment Steps for applying Lugol’s iodine to the cervix Pre-treatment assessment

Treatment by cryotherapy

Principles Cryosurgical unit Ancillary instruments and consumables Steps Side-effects and complications Post-treatment advice and follow-up Video

Treatment by thermal ablation

Principles The benchtop model The battery-operated model Complications Video

Using an HPV test as the test of cure in women treated for cervical abnormalities or cervical intraepithelial neoplasia (CIN) Infection prevention

Standard procedures for protection from infection Essential steps for infection prevention in a cervical cancer screening clinic Preparation of 0.5% chlorine solution

Case studies

VIA triage outcome (applicable in screen-and-treat setting only) – negative cases VIA triage outcome – positive cases VIA triage outcome – suspicious of cancer cases

Foreword Acknowledgement Authors Suggested citation Copyright

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Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide

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Acknowledgement

The development of Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide was made possible by the contributions and active support of many individuals.

We thank all the reviewers for their essential and constructive feedback on this voluminous work:

Dr Dipanwita Banerjee, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
Dr Usha Rani Poli, Consultant, Gynaecological Oncologist, Public Health Foundation of India, Hyderabad, India
Dr Katayoun Taghavi, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
Ms Vanessa Tenet, Early Detection, Prevention, and Infections Branch, IARC

We thank the following providers of images:

BC Cancer, Provincial Health Services Authority, British Columbia, Canada
YouScreen, NHS, North Central London Cancer Alliance, United Kingdom
Ms Morena Sarzo, IARC
Ms Namakau Nyambe University of North Carolina at Chapel Hill, Global Projects-Zambia, Lusaka, Zambia
Dr Sreeya Bose (Chittaranjan National Cancer Institute, Kolkata, India)
Dr Usha Rani Poli, Public Health Foundation of India, Hyderabad, India
Figure reproduced from Woodman et al., The natural history of cervical HPV infection: unresolved issues, Nature Reviews Cancer, volume 7, pages 11-22, 2007, Springer Nature
Figure reproduced from Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. Summary Report 22 October 2021. 20/02/2023. ©ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre) 2022
Figure reproduced from Canfell et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries, The Lancet, Volume 395, issue 10224, pages 591-603. © 2020 Canfell et al. Published by Elsevier Ltd.
DAPA images/Canva
dmitroscope/Adobestock
Science Photo Library/Canva
World Health Organization

We are indebted to Dr Elisabete Weiderpass, Director of IARC, for her constant encouragement and support to the project.

We could not have achieved such a high-quality finished product without assistance from Ms Krittika Guinot of the Early Detection, Prevention, and Infections Branch at IARC. We gratefully acknowledge the contributions and valuable suggestions made by Dr Karen Müller (Managing Editor) and Ms Sylvia Lesage.

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