Clinical Practice Guidelines on the Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention in Saudi Arabia

Abstract

BACKGROUNDCervical cancer is the third most common gynecological malignancy in Saudi women with an estimated incidence rate of 1.9 cases per 100 000 women-years. More than 40% of cervical cancer cases are diagnosed at advanced stages due to lack of a routine screening program in Saudi Arabia. Thus, national guidelines for routine screening and treatment of precancerous cervical lesions are needed.METHODSThe Saudi Centre for Evidence-Based Healthcare invited a panel of local experts and partnered them with a team from McMaster University in Canada for methodological support, to develop national clinical practice guidelines on the screening and treatment of precancerous lesions for cervical cancer. After the panel identified key clinical questions, the McMaster University working group updated existing systematic reviews that had been used for the 2013 WHO Guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Recommendations were based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. Those recommendations took into account the available evidence, patient values and preferences, and resource use in the Saudi context. The panel provided recommendations on two major issues: screening for precancerous lesions (cervical intraepithelial neoplasia 2 & 3) and treatment of those lesions to prevent cervical cancer in women who tested positive after screening.CONCLUSIONSThe Saudi expert panel recommends using the HPV DNA test followed by colposcopy or cytology (Pap test) followed by colposcopy to screen for CIN2+ in women at risk of cervical cancer. The panel recommends cryotherapy or loop excision electrosurgery procedure (LEEP) over cold knife cone biopsy to treat women at risk of cervical cancer that tests positive for CIN2+. Universal screening for precancerous cervical dysplasia in women in Saudi Arabia is recommended using HPV testing and or cytology. Either cryotherapy or LEEP are preferred for treatment.LIMITATIONSNational studies on cervical cancer screening modalities and treatment of precancerous cervical lesions, including HPV prevalence and its association with cervical cancer, are scarce.

Retracted: MicroRNA‐497 accelerates apoptosis while inhibiting proliferation, migration, and invasion through negative regulation of the MAPK/ERK signaling pathway via RAF‐1

“…Multiple studies have exhibited that CC is one of the most prevalent malignant tumor in women with a high mortality in developing countries and the drug resistance requires novel anti neoplasm drugs and neo‐chemotherapy strategies (Al‐Mandeel et al, ; Xia et al, ; Yang et al, ). More and more evidences show that aberrantly expressed miRNAs play vital role in the process of tumorigenesis of CC, and thorough understanding of the underlying mechanisms of the small, single‐stranded RNAs may contribute to new treatment regimens for patient with CC (Wang et al, ; Xu et al, ).…”

Integrative review of cervical cancer screening in Western Asian and Middle Eastern Arab countries

“…Two were related to general gynecological cancer services in Arab countries (Ortashi & Al Kalbani, ) and general cancer control in the Gulf (Al‐Othman et al, ). Empirical research was not reported in two papers (Al‐Mandeel et al, , K. Sait, Bentley, Anfinan, & Power, ), leaving 13 for inclusion in the integrative review.…”

Demonstration of Abnormal Cervical Change in Papanicolaou Smears by Liquid Base Cytology

“…Of these 271 women, 143 (52.8%) will die due to the disease, including 27 (39.7%) at the child-bearing age [3]. A dramatic increase in the incidence of cervical cancer in Saudi Arabia is anticipated [4].…”