Cervical Cancer Screening Learning Module F O R H E A L T H C A R E P R O V I D E R S INITIATE LEARNING AND COMPETENCY TO PERFORM CERVICAL CANCER SCREENING MENTOR COLLEAGUES TO BECOME COMPETENT IN SCREENING REVIEW CURRENT RESEARCH AND TRENDS IN CERVICAL CANCER SCREENING cancercare.mb.ca/screening/hcp 1-855-95-CHECK X-PTLM Cervical Cancer Screening Learning Module for Health Care Providers Legal Disclaimer and Terms of Use The information in this Module is public information and should not be used as a substitute for any kind of professional medical advice, diagnosis or treatment. All copyrights are reserved by CervixCheck, CancerCare Manitoba (herein referred to as CervixCheck). No part of the Module may be reproduced, distributed or transmitted in any form or by any means, or stored in a database or retrieval system, without the prior written consent of the Program Manager, CervixCheck, unless such reproduction, transmission or storage is solely for the purpose of using the Module for personal use only. For information regarding permission, please contact CervixCheck. CervixCheck makes no representations or warranties in relation to the contents of the Module. While CervixCheck strives for accuracy, it is possible that the information in the Module may contain errors and omissions. CervixCheck reserves the right to review, update and/or amend the Module, from time to time, in its sole discretion, without recourse from any user of the Module. All references to the Module herein shall include any amended Module. Contact Person Education & Prevention Lead CancerCare Manitoba Prevention & Screening Unit 5 – 25 Sherbrook St., Winnipeg, Manitoba R3C 2B1 Phone: 1-855-95-CHECK Email: [email protected] Website: cancercare.mb.ca/screening/hcp CREATED: JUNE 2009 LAST UPDATED: FEBRUARY 2021 CERVICAL CANCER SCREENING cancercare.mb.ca/screening/hcp LEGAL DISCLAIMER- 1 LEARNING MODULE FOR HEALTHCARE PROVIDERS Acknowledgements Permission has been given to reproduce in part or whole, sections of the Alberta Cervical Cancer Screening Program (ACCSP) Registered Nurse Pap Smear Learning Module. Thank you to the ACCSP for permission to use this module as a guide for our work. CervixCheck, CancerCare Manitoba (CervixCheck) would like to acknowledge the following health care providers who contributed to the development and review of this learning module: Connie Beaton Primary Care Nurse Youth/Women’s Team NOR-MAN RHA Lorraine Cameron-Munro Registered Nurse, Nine Circles Community Health Centre Carolyn Clarke Women’s Health Clinic Practitioner, Women’s Health Clinic Alain Demers Team Leader, Department of Epidemiology, CancerCare Manitoba Dr. Mike Dillon Medical Director, Klinic Community Health Centre Elsie Duff Nurse Practitioner, Selkirk Teen Clinic, Interlake RHA Kim Froese Registered Nurse, Mount Carmel Clinic Lisa Goss Reproductive Health Nurse Coordinator, Klinic Diane Gudmundson Nurse Practitioner, Teen Clinic, Central RHA Wendy Kowaluk-Crozier Clinical Resource Nurse, Kildonan Medical Centre Cynthia Lathlin Aboriginal Liason Worker, Burntwood Community Health Resource Centre Dr. William Libich Medical Officer of Health, WRHA, Family Physician, Klinic Dr. Robert Lotocki Medical Director, CervixCheck, CancerCare Manitoba Jo-Anne Lutz Program Manager, Public Health, Burntwood RHA Sandy May Nurse Practitioner, North Eastman Health Association Lea Mutch Registered Nurse, Aboriginal Health and Wellness Louise Rawluk Nurse Practitioner, Burntwood Community Health Resource Centre Candice Rookes Director of Wellness, Aboriginal Health and Wellness Centre Trish Sattleberger Regional Educator, Staff Education, NOR-MAN RHA Brenna Shearer Program Manager, CervixCheck, CancerCare Manitoba Glenda Short Executive Director, Allied Health Services, Assiniboine RHA Kimberly Templeton Recruitment and Health Promotion Specialist, CervixCheck Donalda Wotton Community Care Analyst, WRHA A special thank you to Lisa Goss, Reproductive Health Nurse Coordinator, Klinic Community Health Centre, for her enthusiasm and generous contributions to the development of this learning module. CervixCheck would like to acknowledge Klinic Community Health Centre for their generous resources and support in the development of this module. CERVICAL CANCER SCREENING LEARNING MODULE FOR cancercare.mb.ca/screening/hcp HEALTHCARE PROVIDERS - iii - Endorsements The Pap Test Learning Module for Healthcare Providers has been endorsed by the following organizations: • College of Midwives of Manitoba • The College of Physicians and Surgeons of Manitoba • The Manitoba College of Family Physicians* • The University of Manitoba Department of Obstetrics, Gynecology and Reproductive Sciences • The University of Manitoba Division of Gynecologic Oncology CERVICAL CANCER SCREENING LEARNING MODULE FOR cancercare.mb.ca/screening/hcp HEALTHCARE PROVIDERS - iv - Table of Contents 1. Introduction • Target Audience & Purpose • Client-Centered Service • Learning Objectives • Competency Requirements • Competency Requirements Summary Table • Obtaining a CervixCheck Provider Number • Scope of Practice for those who can Perform Pap Tests • Professional Responsibility & Accountability • Medicolegal Issues Cervical Cancer Screening Learning Module Pre-Test 2. Disease Burden and Cervical Cancer Screening in Manitoba • Cervical Cancer • HPV Disease Burden • Natural History • Risk Factors for HPV and Cervical Cancer • Organized Cervical Cancer Screening in Manitoba: CervixCheck, CancerCare Manitoba 3. Cervical Cancer Screening Guidelines • Who Should Have a Pap Test and How Frequently? o Screening initiation o Screening interval o Screening cessation o Individuals who have never been sexually active o Clients who have had the HPV vaccine o Clients who are pregnant o Clients who have had a hysterectomy o Lesbian clients or women who have sex with women o The transgender client o Clients who require increased surveillance CERVICAL CANCER SCREENING LEARNING MODULE FOR cancercare.mb.ca/screening/hcp TABLE OF CONTENTS- 1 HEALTHCARE PROVIDERS o Clients who have had previous high grade cytology results • Key Messages for Health Care Providers • Benefits & Harms of Cervical Screening: Facilitating Informed Decision-Making 4. Counseling and Education • Before the Exam • During the Exam • After the Exam 5. Facilitating an Inclusive Environment • Barriers to Access • Lesbian Clients, WSW and Transgender People • Clients with a History of Sexual Abuse • Vaginismus • Clients with Disabilities • Clients with Diverse Language and Cultural Considerations • Female Genital Cutting (FGC) 6. Physiology, Anatomy, Abnormal Findings • Developmental Changes in the External and Internal Genitalia • External Genitalia • Internal Genitalia • The Cervix • Identifying Abnormal and Normal Cervical Appearances • Female Genital Cutting • Normal versus Abnormal Uterine Bleeding • Summary Chart of Genital Discharges, Infections, Ulcers and Lesions 7. Health History • Sexual and Reproductive Health History Review • Review of Related History CERVICAL CANCER SCREENING LEARNING MODULE FOR cancercare.mb.ca/screening/hcp TABLE OF CONTENTS- 2 HEALTHCARE PROVIDERS 8. External & Speculum Exam • Exam Equipment • Preparing the Client • External Examination • Speculum Exam Procedure • Special Considerations 9. The Papanicolaou Test • Ideal Conditions for Taking Pap Tests • Liquid Based Cytology • The Pap Test Procedure: Liquid Based Cytology • The Vaginal Vault Procedure: Liquid Based Cytology • How to Document a Pap Test • Cervical Cytology Request and Colposcopy Report Forms • CervixCheck Provider Number 10. Cervical Cancer Screening Test Results • The Bethesda System • Specimen Adequacy • Unsatisfactory for Evaluation • Satisfactory for Evaluation • Management of Cytology Results • Other Results • Limitations of Pap Test Results • Talking to Clients about Abnormal Pap Test Results • Colposcopy 11. New Technologies • The HPV Vaccines • HPV Testing CERVICAL CANCER SCREENING LEARNING MODULE FOR cancercare.mb.ca/screening/hcp TABLE OF CONTENTS- 3 HEALTHCARE PROVIDERS 12. Pap Test Access • Increasing Access to Cervical Cancer Screening Services: The Pap Test Clinic • Preparing for a Pap Test Clinic Cervical Cancer Screening Learning Module Post-Test Glossary Appendices 1. Education a. Cervical Cancer Screening Learning Module Videos b. Pap Test Procedure Sampling Technique c. Resources & Tools 2. Forms a. Screening History Request b. Cytology Requisition c. Colposcopy Report d. CervixCheck Provider Number Request Form 3. Assessment Tools a. Pre & Post Test Answer Key b. Performance Criteria Checklist for Preceptor 4. Case Studies CERVICAL CANCER SCREENING LEARNING MODULE FOR cancercare.mb.ca/screening/hcp TABLE OF CONTENTS- 4 HEALTHCARE PROVIDERS Chapter 1: Introduction Welcome to the CervixCheck, CancerCare Manitoba’s Cervical Cancer Screening Learning Module for Health Care Providers (HCPs). This module has been developed in consultation with Manitoba stakeholders in cervical cancer screening. It has been adapted with permission from the Alberta Cervical Cancer Screening Programs (ACCSP) Registered Nurse Pap Smear Learning Module. The Cervical Cancer Screening Learning Module can be found at: cancercare.mb.ca/screening/hcp Target Audience and Purpose The Cervical Cancer Screening Learning Module is for physicians, registered nurses, advanced practice nurses, licensed practical nurses, registered midwives, clinical assistants and/or physician assistants in Manitoba seeking to: • Initiate learning about cervical cancer and competency to perform