GOSB Guideline for continuation of cervical cancer screening during the COVID-19 crisis

GOSB Guideline for continuation of cervical cancer screening during the COVID-19 crisis

Introduction: The scale of the COVID-19 pandemic and the impact on health care services will inevitably necessitate modifications to how we would usually care for women with gynecological cancers. Cervical cancer is the most common gynecological cancer both in incidence and mortality in Bangladesh.

Bearing in mind the mortality rate related to cervical cancer, screening should be resumed in the COVID-19 containment strategy.

Objectives :

1. To continue screening for high-risk women only.
2. To follow COVID-19 preventive measures while providing screening.
3. To provide treatment for high-grade cervical disease (III or above) without invasion.

 

High-risk women should be offered for screening (Leaflet should be printed) Selection by Midwives

1. Age >35 yrs
2. Married before 16 yrs of age.
3. No previous screening test.
4. Childbirth before 18 years.
5. Repeated childbirth.
6. Multiple sexual partners of both husband or wife.
7. HIV infection or other sexually transmitted diseases.
8. Use of OCP for more than 5 years.
9.  
10. Opportunistic screening.
11. Screening is previously appointed.

 

COVID-19 PREVENTIVE MEASURES SHOULD BE STRICTLY FOLLOWED:  

Client enter through the Disinfection Chamber

History taking, criteria fulfils

 

Individual appointment each day to avoid overcrowding.

 

 

 

Number of client limited (6-8)

 

 

 

One meter distanced queues.

 

Instructions to the client during Appointment:

 

1. Wearing Face Mask, Face Shield, Hand Gloves mandatory.
2. Wait outside until appointment.
3. Waiting time may be longer than normal.
4. Only client will be allowed in the service room.
5. To bring personal pen to sign the screening form.
6. Two way entrance and leaving the service room.

 

Criteria for Reschedule:

 

1. Have symptoms of Corona Virus infection
2. Are self-isolating because her close contact of someone who has tested positive for Corona Virus.
3. Need to postpone her appointment.

Instruction to the service providers (Doctors/Nurse/Mid wives/FWA/Health Assistant):

1. Wearing of N-95 Mask, Face Shield, PPE and gloves.
2. Limited no. of service provider, one for one patient.
3. Frequent hand washing.
4. Proper record keeping and sent to MIS of DGHS.

Use of Telehealth for cervical cancer screening:

1.  
2. Phone calls.
3. Text messages.
4. E-mail

 

Tele health service involve:

 

1. Counseling service.
2. Appointment for Screening, Colposcopy or Treatment.
3. Provide test result of pap’s, HPV test or Histopathology report.

 

Frequency of screening:

 

1. 5 years interval.
2. Co-testing by HPV-DNA+Pap’s - interval can be up to 10 yrs.

 

Test methods:

 

1. VIA up to 50 yrs (up to 60 if facility for pap’s is not available)
2. Pap’s up to 65 yrs (provided 2 negative smear in last 10 years).
3. HPV DNA testing up to 70 years.

Further test (Colposcopy) and treatment

 

Introduction : According to ASCCP, IGCS and ASGO guideline (March 2020) all elective procedure were suspended due to COVID-19 but since introduction of COVID-19 on 8^th march 2020 in Bangladesh, already 3 months have passed. So we have to think about the elective procedures like colposcopy, cold coagulatiooon, cryotherapy and LEEP procedure.

Interim Guidance for Colposcopy Timing and Treatment Protocol for Patients with Abnormal Cervical Screening Tests.

According to 26.06.2020 ASCCP  Guideline in light of the current unpredicted COVID-19 pandemic.

Instructions to the service providers:

1. Primary goals are:
2. To protect patients health
3. To limit viral transmission to professionals and office staffs.

 

Recommendations for colposcopy:

• Low grade cervical screening result (CIN I): LSIL on pap’s or VIA, colposcopy postponed up 6-12 months but if necessary can be done immediately.
• High grade cervical screening result (CINII  & CIN III): Colposcopy within 3 months but can be done immediately .

 

Note: It is still controversial. Each case should be judged according to their clinical criteria.

Treatment procedure:

1. Cryotherapy: Can be used according to selection criteria.
2. Cold coagulation: Still controversial as there is aerosol generation.
3. LEEP: Still controversial as there is huge aerosol generation and large number of service providers needed.
4. Cone biopsy: As no aerosol generated, can be used in well equipped O.T by experienced surgeon obeying every rules for protection of patients and O.T staff from COVID-19.

Note: GOSB states that the above recommendations should not be considered “definitive management guidelines”, but rather management should take into account according to clinical scenario and review “case by case”.