Nancy Santesso1, Reem A Mustafa2, Holger J Schünemann3, Marc Arbyn4, Paul D Blumenthal5, Joanna Cain6, Michael Chirenje7, Lynette Denny8, Hugo De Vuyst9, Linda O'Neal Eckert10, Sara E Forhan11, Eduardo L Franco12, Julia C Gage13, Francisco Garcia14, Rolando Herrero9, José Jeronimo15, Enriquito R Lu16, Silvana Luciani17, Swee Chong Quek18, Rengaswamy Sankaranarayanan9, Vivien Tsu15, Nathalie Broutet19. 1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Departments of Internal Medicine/Nephrology and Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO, USA. 3. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Electronic address: schuneh@mcmaster.ca. 4. Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium. 5. Stanford University School of Medicine, Stanford, CA, USA. 6. University of Massachusetts Medical School, Worcester, MA, USA. 7. University of Zimbabwe, Harare, Zimbabwe. 8. University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa. 9. International Agency for Research on Cancer, Lyon, France. 10. Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA. 11. Centers for Disease Control and Prevention, Atlanta, GA, USA. 12. McGill University, Montreal, QC, Canada. 13. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. 14. American Cancer Society, Tucson, AZ, USA. 15. PATH, Seattle, WA, USA. 16. Jhpiego, Baltimore, MD, USA. 17. Cancer Prevention and Control PAHO, Washington, DC, USA. 18. KK Women's and Children's Hospital, Singapore, Singapore. 19. Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Abstract
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.
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.
Authors: Ana Cecilia Rodríguez; Carlos Ávila; Rolando Herrero; Allan Hildesheim; Mark E Sherman; Robert D Burk; Jorge Morales; Mario Alfaro; Diego Guillén; María Ethel Trejos; Rosa María Vargas; Guillermo Torres; Mark Schiffman Journal: Int J Cancer Date: 2017-02-07 Impact factor: 7.396
Authors: Gaudence Niyonsenga; Darius Gishoma; Ruth Sego; Marie Goretti Uwayezu; Bellancille Nikuze; Margaret Fitch; Pierre Céléstin Igiraneza Journal: Can Oncol Nurs J Date: 2021-07-01
Authors: Gaudence Niyonsenga; Darius Gishoma; Ruth Sego; Marie Goretti Uwayezu; Bellancille Nikuze; Margaret Fitch; Pierre Céléstin Igiraneza Journal: Can Oncol Nurs J Date: 2021-07-01