World Health Organization Guidelines for treatment of cervical intraepithelial neoplasia 2-3 and screen-and-treat strategies to prevent cervical cancer
Department of Obstetrics and Gynecology
Female Urogenital Diseases and Pregnancy Complications | Maternal and Child Health | Obstetrics and Gynecology | Women's Health
BACKGROUND: It is estimated that 1%-2% of women develop cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) annually worldwide. The prevalence among women living with HIV is higher, at 10%. If left untreated, CIN 2-3 can progress to cervical cancer. WHO has previously published guidelines for strategies to screen and treat precancerous cervical lesions and for treatment of histologically confirmed CIN 2-3.
METHODS: Guidelines were developed using the WHO Handbook for Guideline Development and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. A multidisciplinary guideline panel was created. Systematic reviews of randomized controlled trials and observational studies were conducted. Evidence tables and Evidence to Recommendations Tables were prepared and presented to the panel.
RESULTS: There are nine recommendations for screen-and-treat strategies to prevent cervical cancer, including the HPV test, cytology, and visual inspection with acetic acid. There are seven for treatment of CIN with cryotherapy, loop electrosurgical excision procedure, and cold knife conization.
CONCLUSION: Recommendations have been produced on the basis of the best available evidence. However, high-quality evidence was not available. Such evidence is needed, in particular for screen-and-treat strategies that are relevant to low- and middle-income countries.
DOI of Published Version
Int J Gynaecol Obstet. 2016 Mar;132(3):252-8. doi: 10.1016/j.ijgo.2015.07.038. Epub 2015 Dec 14. Link to article on publisher's site
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
Santesso N, Schunemann HJ, Cain J. (2016). World Health Organization Guidelines for treatment of cervical intraepithelial neoplasia 2-3 and screen-and-treat strategies to prevent cervical cancer. Obstetrics and Gynecology Publications and Presentations. https://doi.org/10.1016/j.ijgo.2015.07.038. Retrieved from https://escholarship.umassmed.edu/obgyn_pp/138