WHO Guidelines for Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention

Cervical intraepithelial neoplasia (CIN) is a premalignant lesion that may exist at any one of three stages: CIN1, CIN2, or CIN3. If left untreated, CIN2 or CIN3 (collectively referred to as CIN2+) can progress to cervical cancer. Instead of screening and diagnosis by the standard sequence of cytology, colposcopy, biopsy, and histological confirmation of CIN, an alternative method is to use a ‘screen-and-treat’ approach in which the treatment decision is based on a screening test and treatment is provided soon or, ideally, immediately after a positive screening test. Available screening tests include a human papillomavirus (HPV) test, visual inspection with acetic acid (VIA), and cytology (Pap test). Available treatments include cryotherapy, large loop excision of the transformation zone (LEEP/LLETZ), and cold knife conization (CKC).

This guideline provides recommendations for strategies for a screen-and-treat programme. It builds upon the existing WHO guidelines: Use of cryotherapy for cervical intraepithelial neoplasia (published in 2011) and on the new WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and glandular adenocarcinoma in situ (forthcoming). This guideline is intended primarily for policy-makers, managers, programme officers, and other professionals in the health sector who have responsibility for choosing strategies for cervical cancer prevention, at country, regional and district levels.

Contents

• Lists of participants
• Process for managing declarations and conflicts of interest
• Acknowledgements
• Acronyms and abbreviations
• Executive summary
• Screen-and-treat strategy summary recommendations
• 1. Introduction
  • Target audience
  • Purpose
• 2. Methods
  • Guideline groups
  • Formulating questions and determining outcomes
  • Synthesis of the evidence and preparation of evidence profiles
  • Modelling of health outcomes
  • Development of the recommendations
  • Guideline review and approval process
• 3. Recommendations
  • Important considerations that apply to all screen-and-treat recommendations
  • Screen-and-treat recommendations
• 4. Research gaps and further considerations
• 5. Use of the guideline
  • Guideline dissemination
  • Guideline evaluation
  • Guideline update
• References
• Annexes
  • Annex 1 Declarations of interest
  • Annex 2 Decision-making flowchart for screen-and-treat strategies
  • Annex 3 Flowcharts for screen-and-treat strategies (negative or unknown HIV status)
  • Annex 4 Flowcharts for screen-and-treat strategies (HIV-positive status or unknown HIV status in areas with high endemic HIV infection)
  • Annex 5 Search strategies for evidence reviews
  • Annex 6 PRISMA flow diagram for inclusion and exclusion of studies for evidence reviews
  • Annex 7 Reference list of all studies included in the evidence reviews
• Supplemental material

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