Showing posts with label LEEP. Show all posts
Showing posts with label LEEP. Show all posts

Thursday, May 24, 2018

3-D Printed Models of cervix developed to train doctors in cervical cancer screening and treatment

The researchers from Rice University

Many resource-poor settings are not able to provide cervical cancer screening, diagnosis, and treatment of women population because of lack of training. A team of students from Rice University has designed a 3-D Printed Models of the cervix that can help the healthcare providers to train them to carry out screening and provide treatment for cervical cancer.

This will be specifically used for training doctors and nurses in developing countries and low-resource areas in the U.S.

Cervical cancer kills nearly 300,000 women every year and more than 80% deaths are reported in developing countries. In about 90% of patients, the cervical cancer is preventable.



Rice students Christine Luk, Elizabeth Stone and Rachel Lambert are senior design students enrolled in the course Global Health Design. Together with graduate student Sonia Parra, they developed a low-cost, interactive training model that mimics a woman’s pelvic region and can be used to practice different cervical cancer screening and treatment procedures.

The simple device includes different models of cervix showing evolving stages of cervical cancer from entirely normal to pre-cancerous to definitive cancer.  The models fit into holder placed at the back of the device.

The training doctor or nurse can have real-life experience of what it looks like at the doctor’s office after the speculum is inserted and the cervix is visualized. The models can easily be switched around to simulate different conditions of the cervix and they also respond to the application of hot water just as a gynecologist applies acetic acid in clinical settings.

In addition to the training aspect, the device also is handy in teaching the doctors and nurses about how to proceed with abnormal results of the screening tests or a lesion is seen during the examination.

Some cervical models are made of a ballistic gel, that allows the doctors to practice colposcopy, cervical biopsy; cryotherapy, and loop electrosurgical excision procedure at low costs.

“Here in the states we have the ability to perform Pap smears and other practices, but in other countries where this model is used, such as Mozambique and El Salvador, they may not have the necessary infrastructure to do so,” Christine Luk said. “That’s why it’s important that this model can train as many procedures as possible.”

The students have already tested the device in training clinics in El Salvador and the Rio Grande Valley in Texas. Each training session is modified to fit the specific needs of an area.

The team from Rice is trying to collaborate with manufacturers to mass produce the device for areas in need so newly trained medical providers can train others.


Here is a video about how the device works





Wednesday, October 12, 2016

ASCO issues new evidence based recommendations for global cervical cancer screening.

AmericanSociety of Clinical Oncology (ASCO)[i]  releases new resource stratified, evidence based global screening guidelines for secondary prevention of cervical cancer. ASCO called upon multidisciplinary, multinational team of cancer control, public health, oncology, epidemiology, primary care and patient advocacy experts to review the earlier guidelines and formulate recommendations according to the resources available.  

The panel of expert identified 7 existing guidelines, reviewed them and formed the evidence base, along with cost effective analysis and four systematic reviews leading to more than 75% agreement.

The basic aim of the guidelines was utilizing the resources available in countries across the globe to screen the maximum number of women to detect precancerous lesions and treatment and follow-up thereafter.

According to Medscape Surendra S. Shastri, MD, MBBS, co-chair of the ASCO expert panel that developed the guideline and professor of preventive oncology at Tata Memorial Center in Mumbai, India said "Every woman ― no matter where she lives ― should have at least one good cervical cancer screen in her lifetime, but unfortunately, we are not even close to that."

The guidelines were published online October 12 in the Journal of Global Oncology.[ii]

The countries around the world are divided into 4 tier based on available healthcare resources- maximal resources, enhanced resources, limited resources and basic resources. Countries with most resources are in the maximal resource group while countries with very limited resources were labelled as into basic resources group.

The panel then evaluated that what type of screening will be suitable for each tier.

Key Recommendations as published in the Journal of Global Oncology:

Primary Screening

  • Human papillomavirus (HPV) DNA testing is recommended in all resource settings.
  • Visual inspection with acetic acid may be used in basic settings.
  • The recommended age ranges and frequencies in each setting are as follows:
    • Maximal: 25-65 years, every 5 years
    • Enhanced: 30-65 years, if two consecutive negative tests at 5-years intervals, then every 10 years
    • Limited: 30-49 years, every 10 years
    • Basic: 30-49 years, one to three times per lifetime
Exiting Screening

  • Maximal and enhanced: ≥ 65 years with consistently negative results during past ≥ 15 years
  • Limited and basic: ≤ 49 years, resource-dependent; see specific recommendations
Triage

  • In basic settings, visual assessment for treatment may be used after positive HPV DNA testing results.
    • If visual inspection with acetic acid was used as primary screening with abnormal results, women should receive treatment.
  • For other settings, HPV genotyping and/or cytology may be used.
After Triage

  • Women with negative triage results should receive follow-up in 12 months.
  • In basic settings, women should be treated if there are abnormal or positive triage results.
  • In limited settings, women with abnormal results from triage should receive colposcopy, if available, or visual assessment for treatment, if colposcopy is not available.
  • In maximal and enhanced settings, women with abnormal or positive results from triage should receive colposcopy.
Treatment of Women With Precursor Lesions

  • In basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure (LEEP).
  • In other settings, LEEP (if high level of quality assurance) or ablation (if medical contraindication to LEEP) is recommended.
  • Twelve-month post-treatment follow-up is recommended for all settings.
Special Populations

  • Women who are HIV positive or immunosuppressed for other reasons should be screened with HPV as soon as diagnosed and screened twice as many times in a lifetime as the general population.
  • The management of abnormal screening results for women with HIV and positive results of triage is the same as in the general population
  • Women should be offered primary screening 6 weeks postpartum in basic settings and 6 months postpartum in other settings.
  • Screening may be discontinued in women who have received a total hysterectomy for benign causes with no history of cervical dysplasia or HPV. Women who have received a subtotal hysterectomy (with an intact cervix) should continue receiving routine screening.




[i] https://pilotguidelines.atlassian.net/wiki/display/SPCCRG/Secondary+Prevention+of+Cervical+Cancer+Resource-Stratified+Guideline+Home
[ii] http://jgo.ascopubs.org/content/early/2016/10/08/JGO.2016.006577.full#abstract-1