Guidelines for the prevention and diagnosis of vaginal and vulvar cancers: A systematic review
Variation in care is known to exist for those diagnosed with vaginal and vulvar cancers. Guidelines are integral to providing a consistent, quality standard of care. To provide an evidence-based background for vaginal and vulvar cancers, a systematic review was conducted to identify available guidelines relevant to prevention and early detection; presentation, initial investigations and referral; and diagnosis. We conducted a systematic search of databases (CINAHL, Cochrane Library, Embase, PubMed, Scopus, Web of Science) and targeted websites (n = 23) to identify guidelines published in English within the past 10 years (from 2013 onwards) relevant to either vaginal or vulvar cancers and pertaining to the first three steps of the cancer care continuum. We screened the guidelines, extracted recommendations and statements, and assessed their quality using standard forms. A total of 45 guidelines were included in this review (33 evidence-based, 12 consensus-based). Guidelines were developed by a range of professional organisations and across countries. Guidelines covered multiple topics including prevention and early detection (n = 37; 82 %), presentation, initial investigations and referral (n = 24; 53 %), and diagnosis (n = 23; 51 %). Common and consistent guideline recommendations and statements were identified. Example recommendation topics included risk factors, management of precursor conditions, signs and symptoms, initial tests and referral, and diagnostic workup. Few timeframes were specified. This review has collated relevant and current guidelines available to health professionals from prevention to diagnosis of vaginal and vulvar cancers. Our synthesis demonstrates consistency but a lack of specificity in the available recommendations/statements.