The following flowcharts describe the steps for each of the screen-and-treat strategies that are available. The flowcharts do not indicate which strategy is preferred. Refer to the screen-and-treat recommendations provided in Chapter 3 of the WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention (2013)15 for guidance about which strategies are recommended, and to the decision-making flowchart in Annex 7. For detailed information about the specific factors the guideline panel considered when making the recommendations, refer to the evidence-to-recommendation tables for each recommendation presented in that guidance (Supplemental material, Sections A and B).
Screen with an HPV test and treat with cryotherapy, or LEEP when not eligible for cryotherapy
When an HPV test is positive, treatment is provided. With this strategy, visual inspection with acetic acid (VIA) is used to determine eligibility for cryotherapy.
Note: Refer to the screen-and-treat recommendations provided in Chapter 3 of the WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention (2013) for guidance about which strategies are recommended, and for information on the specific factors to consider when deciding on a strategy.
Screen with an HPV test followed by VIA and treat with cryotherapy, or LEEP when not eligible for cryotherapy
When an HPV test is positive, then VIA is provided as a second screening test to determine whether or not treatment is offered. Treatment is only provided if BOTH the HPV test and VIA are positive.
Note: Refer to the screen-and-treat recommendations provided in Chapter 3 of the
WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention (2013) for guidance about which strategies are recommended, and for information on the specific factors to consider when deciding on a strategy.
16Screen with VIA and treat with cryotherapy, or LEEP when not eligible for cryotherapy
Note: Refer to the screen-and-treat recommendations provided in Chapter 3 of the
WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention (2013) for guidance about which strategies are recommended, and for information on the specific factors to consider when deciding on a strategy.
17Screen with an HPV test followed by colposcopy (with or without biopsy)18 and treat with cryotherapy, or LEEP when not eligible for cryotherapy
Note: Refer to the screen-and-treat recommendations provided in Chapter 3 of the
WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention (2013) for guidance about which strategies are recommended, and for information on the specific factors to consider when deciding on a strategy.
19Screen with cytology followed by colposcopy (with or without biopsy)20 and treat with cryotherapy, or LEEP when not eligible for cryotherapy
Note: Refer to the screen-and-treat recommendations provided in Chapter 3 of the
WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention (2013) for guidance about which strategies are recommended, and for information on the specific factors to consider when deciding on a strategy.
21- 15
- 18
Women with positive colposcopic impression can receive biopsy for histological confirmation or be immediately treated.
- 20
Women with positive colposcopic impression can receive biopsy for histological confirmation or be immediately treated.
