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The Pap Test PowerPoint Presentation

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Description : Check out this medical presentation on Cervical Cancer, which is titled "The Pap test", to know about the Papanicolaou (Pap) smear test and how it works, infrastructure requirements, what test results mean, test performance, strengths and limitations, and program implications in low-resource settings. Pap test is a vaginal speculum exam during which a health care provider takes a sample of cells from a womans cervix using a small flat spatula or brush.

Tags : Cervical Cancer, Pap test, Papanicolaou smear test, vaginal speculum exam, cervix

Published on : May 13, 2021 | Views : 2753 | Downloads : 1

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Slide 1-

The Pap test: Evidence to date Original source: Alliance for Cervical Cancer Prevention (ACCP) www.alliance-cxca.org
Slide 2-

Overview: Description of the Papanicolaou (Pap) smear test and how it works Infrastructure requirements What test results mean Test performance Strengths and limitations Program implications in low-resource settings
Slide 3-

What does a Pap test involve? Performing a vaginal speculum exam during which a health care provider takes a sample of cells from a woman’s cervix using a small flat spatula or brush. Smearing and fixing cells onto a glass slide. Sending the slide to a cytology laboratory where it is stained and examined under a microscope to determine cell classification. Transmitting the results back to the provider and then to the woman.
Slide 4-

What infrastructure does cytology require? Private exam area Examination table Trained health professionals Sterile vaginal speculum Supplies and equipment for preparing and interpreting the Pap smears (e.g., spatulas, glass slides, fixative, stains, microscopes) Marker/pencil/glass writer/labels Cytology requisition forms Continued…
Slide 5-

What infrastructure does cytology require? (cont.) Record books or sheets Slide mailers Cytology laboratories with skilled personnel to interpret results Pathologists Transportation of slides to the laboratory and back Information systems to ensure follow-up contact with clients Quality assurance system to maximize accuracy
Slide 6-

Categories for Pap test results: Normal results: If no abnormal cells are seen, then the test result is normal. If only benign changes are seen, usually resulting from inflammation or irritation, then the test result is normal. Abnormal results: Atypical cells of undetermined significance (ASCUS, AGUS). Low-grade squamous intraepithelial lesions (LSIL) or cervical intraepithelial neoplasia (CIN) 1. These are mild, subtle cell changes, and most go away without treatment. High-grade squamous intraepithelial lesions (HSIL) or CIN 2 or 3. Moderate and severe cell changes which require further testing or treatment. Carcinoma.
Slide 7-

Management options if the Pap test result is abnormal: For women with low-grade squamous abnormalities (ASCUS or LSIL), give periodic Pap tests until the abnormality resolves, or a colposcopy referral for persistent lesions. Women with glandular abnormalities (AGUS) usually are referred for colposcopy. Women with HSIL usually are referred for colposcopy. Women with HSIL should be treated to remove or destroy the abnormal cells.
Slide 8-

Test performance: Sensitivity and specificity Sensitivity: The proportion of all those with disease that the test correctly identifies as positive. Specificity: The proportion of all those without disease (normal) that the test correctly identifies as negative.
Slide 9-

Pap test performance: Sensitivity = 51% for CIN I or higher Range of 37% to 84% Specificity = 98% for CIN I or higher Range of 86% to 100% These results are from a meta-analyses of cross-sectional studies (AHCPR 1999). Several ACCP studies have also found Pap test sensitivity in the range of 50% at best.
Slide 10-

Strengths of cytology: Historical success in developed countries. High specificity, meaning women with no cervical abnormalities are correctly identified by the test with normal test results. A well characterized screening approach. May have the potential to be cost-effective in middle-income countries.
Slide 11-

Limitations of cytology: Moderate to low sensitivity: High rate of false-negative test results Women must be screened frequently Rater dependent Requires complex infrastructure Results are not immediately available Requires multiple visits Likely to be less accurate among post-menopausal women
Slide 12-

Conclusions: Cytology may be an appropriate screening approach in middle-resource settings with reliable quality control mechanisms. Cytology infrastructural requirements generally make it an impractical approach for many low-resource settings. Decision makers need to carefully consider how existing Pap smear services can be strengthened or whether to explore alterative screening approaches.
Slide 13-

References: ACCP. Pap smears: An important but imperfect method. Cervical Cancer Prevention Fact Sheet. (October 2002). Agency for Health Care Policy and Research (AHCPR). Evaluation of Cervical Cytology. Evidence Report/Technology Assessment, No. 5. Rockville, MD. (1999).
Slide 14-

For more information on cervical cancer prevention: The Alliance for Cervical Cancer Prevention (ACCP) www.alliance-cxca.org ACCP partner organizations: EngenderHealth www.engenderhealth.org International Agency for Research on Cancer (IARC) www.iarc.fr JHPIEGO www.jhpiego.org Pan American Health Organization (PAHO) www.paho.org Program for Appropriate Technology in Health (PATH) www.path.org