Treatment of cervical intraepithelial lesions

Abstract

Precancerous cervical lesions precede the development of invasive cervical cancer by 10-20 years, making cervical cancer preventable if these lesions are detected and effectively treated. Treatment has evolved in the last few decades and now includes ablative options that can be performed in lower-resource settings where surgical excision is not feasible or routinely available. Gas-based cryotherapy, which freezes cervical tissue to induce localized necrosis, is the most commonly used ablative treatment.However, its implementation in low-resource settings is difficult because the refrigerant gas can be difficult to procure and transport, and is expensive. New cryotherapy devices that do not require an external supply of gas appear promising. Thermal coagulation, which burns cervical tissue to induce necrosis, has become more widely available in the last few years owing to its portability and the feasibility of using battery-powered devices. These two ablative treatments successfully eradicate 75%-85% of high-grade cervical lesions and have minor adverse effects. K E Y W O R D SCervical precancer; Cryotherapy; Low-and middle-income country; Thermal coagulation; Treatment | INTRODUCTIONAlthough cervical cancer is preventable, more than half a million women around the world develop this disease every year, and around 270 000 die.1 The main reasons for these unnecessary deaths are the lack of screening, management, and treatment for women at the target age for secondary prevention in many low-and middle-income countries This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

The prevalence of hrHPV among the isolated community in the Highland of Bario, Sarawak, East Malaysia

“…All these can be prevented by employing the screen-and-threat programs (32) as multiple visits for diagnosis and treatment have been consistently shown to be counter-effective (33). Since we already have a robust careHPV system, the acquisition of a portable colposcope and treatment device (34,35) would allow us to carry out the screen-and treat program.…”

The investment case for cervical cancer elimination

“…Despite these advances in screening technology and delivery, they will have limited impact if screening is not followed by effective treatment where needed, embedded within programs with resource‐appropriate management algorithms. Castle et al . point out the exciting advances in thermal coagulation (also known as cold coagulation), which is finding a niche in programs where cryotherapy has proven to be problematic to maintain, especially with the development of two devices designed especially for low‐resource settings.…”

“…Despite these advances in screening technology and delivery, they will have limited impact if screening is not followed by effec ve treatment where needed, embedded within programs with resourceappropriate management algorithms. Castle et al 14 and appropriate terminology are now much be er understood. 18 Scaling up all these ac vi es to na onal programs with coverage reaching even the most marginalized popula ons is the ul mate goal, if we are to achieve elimina on of cervical cancer.…”

A systematic review and meta‐analysis of thermal coagulation compared with cryotherapy to treat precancerous cervical lesions in low‐ and middle‐income countries

“…There are numerous factors influencing uptake of screening programs, including lack of skilled healthcare workers, lack of equipment, and other health system challenges. An important logistical constraint for the sustainability of see‐and‐treat programs is maintenance of cryotherapy devices and the lack of availability of refrigerated gas, owing to its high importation and purchase costs and large‐size cylinders needed for transport to treatment sites . This affects the availability of treatment during screening, and thus the success of screen‐and‐treat programs.…”