Normes et Protocoles de Dépistage des Lésions Précancéreuses du Col de l’Utérus et de Détection Précoce du Cancer du Sein

Objectives

Senegal’s norms and protocols for screening precancerous cervical lesions and early detection of breast cancer provide a national reference framework for cancer prevention, early diagnosis, referral, treatment and quality service delivery. They support cancer-control priorities under the National Strategic Plan for Cancer Control 2015–2020, the National Plan for Health and Social Development, the Emerging Senegal Plan and Sustainable Development Goal 3.4 on reducing premature mortality from non-communicable diseases.[1][2][3][4]

• Prioritise cervical and breast cancers as major non-communicable disease concerns, addressing delayed consultation, mortality, social consequences and barriers to accessing care.[5][2][3]
• Standardise screening, early-detection, clinical decision-making, referral, counter-referral and quality-control procedures across community, health-post, health-centre and hospital levels.[2][4][6]
• Prevent cervical cancer through human papillomavirus vaccination, prevention of sexually transmitted infections, screening for precancerous lesions and timely treatment.[5][3][7]
• Target cervical screening principally at women aged 30 to 69 years, while community messages promote human papillomavirus vaccination for girls aged 9 to 14 years.[8][7]
• Promote breast-cancer awareness, breast self-examination, clinical breast examination, early consultation and referral among people aged 20 to 74 years.[9][10][11]
• Support breast screening through annual clinical breast examination from age 25 and mammography every two years from age 40, with earlier assessment or genetic evaluation for women with a strong family history.[12][13]
• Define screening as systematic, standardised identification of suspected cancer or precancerous lesions in apparently healthy populations, distinct from clinical diagnosis, and pursue early detection to reduce morbidity and mortality through treatment at an earlier, less aggressive stage.[6]

Implementation

The implementation model deconcentrates and decentralises prevention, screening, diagnosis and treatment according to the health-system pyramid, matching service packages, qualified personnel, equipment, reporting tools and referral pathways to each level of care.[1][4][8][11]The framework was developed through a consultative, participatory process led by the Ministry of Health and Social Action’s Division for Non-Communicable Disease Control under the Director-General of Health, with medical regions, districts, hospitals, training institutions, civil society and technical and financial partners involved.[1][14][15]

• Mobilise community health actors, civil-society organisations, religious leaders, traditional medicine practitioners and community networks to provide health education, home visits, social mobilisation, counselling, awareness activities and referral.[9][10][12]
• Use health posts to receive clients, take histories, counsel patients, undertake clinical examination and visual inspection with acetic acid, promote breast self-examination, collect routine data and refer suspected cases.[16][10][13]
• Provide health-centre capacity for cervical cytology, human papillomavirus testing where available, visual inspection with acetic acid, colposcopy, biopsy, cryotherapy, thermocoagulation and excision procedures, alongside breast examination, ultrasound, mammography access, cytology and biopsy.[17][11][18]
• Organise EPS 1 and EPS 2 hospital services around multidisciplinary clinical, laboratory, pathology, imaging, surgical, pharmaceutical, social and information functions, confirming and characterising lesions and referring cancer cases to treatment centres or EPS 3 where needed.[19][20][21]
• Provide EPS 3 capacity for multidisciplinary diagnosis verification, staging or extension assessment, individualised treatment decisions, surgery, chemotherapy, radiotherapy, hormone or targeted therapy, supportive care, psycho-oncology and palliative care.[22][23][24]
• Apply a cervical screen-and-treat pathway using visual inspection with acetic acid or human papillomavirus testing, followed by cryotherapy or thermocoagulation for eligible lesions and colposcopy with biopsy for lesions requiring further assessment.[5][2][25]
• Refer women with a negative visual-inspection result for repeat screening after three years, while a negative human papillomavirus test is followed by repeat testing after five years.[25][26]
• Use breast-care pathways that begin with risk assessment and clinical examination, progress to ultrasound, mammography, cytology or biopsy as appropriate, and provide histological confirmation, staging and multidisciplinary treatment planning for malignant disease.[13][18][21]
• Maintain documentation through consultation registers, community-activity records, patient files, screening-result forms, pathology requests, referral and counter-referral forms, and monthly reports integrated into district or zone reporting and District Health Information System 2.[8][19][7][11]
• Use the Senegal Cancer Registry, registry personnel and information-system functions as listed elements of hospital-level breast-cancer service arrangements.[11][20][12]
• Adapt and update protocols regularly to sustain standardised quality services; the supplied material does not specify numerical performance indicators, a comprehensive evaluation framework, budget allocations, financing plan or quantified funding gap.[6][11][20]

Monitoring & Evaluation

Monitoring is primarily embedded in routine service documentation, referral pathways and health-information reporting for cervical and breast cancer screening, diagnosis and treatment. The framework does not set out a consolidated indicator set, evaluation design, audit schedule, population surveillance targets or formal accountability structure.[2][4][9][21]

• Record cervical-screening attendance and results through consultation registers, referral and counter-referral forms, result-reporting forms and monthly reports.[8][17]
• Integrate monthly facility reports into the wider health-zone or district report and the District Health Information System 2 (DHIS2).[8][22][7]
• Document community mobilisation and communication through home-visit records, community-relay books, discussion-session forms and information, education and communication registers.[8][9][10]
• Use results forms and clinical records for cytology, colposcopy, cryotherapy, thermocoagulation, resection and pathology requests, alongside patient files and referral documentation.[19][22][11][12]
• Maintain referral and counter-referral arrangements and quality-control systems as mechanisms intended to support consistent service quality across levels of care.[2]
• Use the Senegal Cancer Registry (REGSEN), tumour-registry personnel and information staff as part of the information architecture for hospital-level breast-cancer services.[11][20]
• Follow cervical-screening patients after a negative visual inspection with acetic acid result by arranging repeat screening after three years, and repeat human papillomavirus testing after five years where a negative test result is obtained.[25][26]
• Review patients after cryotherapy within two to six weeks to assess healing, and arrange smear testing or colposcopy six to twelve months after treatment.[27]
• Monitor patients and treatments at level-three facilities following diagnostic verification, staging, multidisciplinary case discussion and initiation of an individualised treatment plan.[23][21]
• Arrange breast-health follow-up through annual clinical screening after a normal examination and mammography every two years from age 40 where indicated.[13][18]
• Record detailed colposcopy findings, including transformation-zone characteristics, acetowhitening, lesion features, iodine-negative areas, diagnostic conclusion and biopsy status, on a dated and signed diagram.[28]
• Record clinical breast-examination findings on a dated diagram and refer people with abnormalities for appropriate diagnostic investigation.[29][30]

Costing & Financing

Costing and financing information is limited. The framework identifies substantial infrastructure, workforce, equipment, medicines, diagnostic capacity, communication materials and reporting tools needed across community, primary-care, health-centre and hospital services, but does not provide a budget, costed implementation plan, financing allocation, funding-gap estimate, resource-mobilisation strategy or economic assumptions.[8][7][11][12]

• Recognise that cancer treatment may be costly and inaccessible for many women, with physical, psychological, economic and social effects on patients, families and communities.[5]
• Use the screen-and-treat approach for cervical precancerous lesions, which is characterised as having the best cost-effectiveness ratio among the stated secondary-prevention options.[5][2]
• Use visual inspection with acetic acid as a simple, rapid and low-cost screening approach with good sensitivity and specificity.[26]
• Use cryotherapy as a simple, low-cost treatment option that does not require electricity or anaesthesia, subject to clinical eligibility criteria.[26]
• Provide human papillomavirus vaccination, screening, diagnosis, treatment, referral, pathology, imaging, surgery, chemotherapy, radiotherapy, supportive care and palliative care through service packages adapted to facility level, without stated unit costs or funding allocations.[5][19][22][24]
• Strengthen technical platforms and human resources as implementation requirements, although associated costs and funding sources are not specified.[1]
• Note technical and financial support from Amref Health Africa for developing the document; the amount, period and terms of this support are not specified.[31]