Reference Manual - IARC Screening Group

Treatment and FollowupSchedule a followup appointment for 1 year after the procedure, and givethe woman the name of the service center or clinic to which she shouldreturn. If possible this information should be provided in writing. Finally,the woman should be given a last opportunity to ask any questions shemight have.FollowupThe woman should return for a repeat VIA testing in 1 year. At this visit,after obtaining a history of any problems, the VIA test should be doneand any abnormalities noted. Because the SCJ may not be visible, thecervix should be carefully checked to assess how it has healed andwhether any lesion persists. Criteria for retreatment or referral at this visitare listed in Table 7-8.Table 7-8. Treatment Status and Recommended ActionVIACLASSIFICATIONVIA Test-NegativePersistentProgressedOther ReferralDESCRIPTIONSCJ visibleNo acetowhite lesionVIA test-positive a , butlesion(s) less than 75% ofsurface area of cervixVIA test-positive withlarger lesion(s) than whentreated or now coveringmore than 75% of thesurface areaPersistent lesions thatqualify for retreatmentwith cryotherapy, butpatient requests referralfor a different method oftreatmenta Acetowhite lesion present regardless of whether SCJ is visible.RECOMMENDEDACTIONRepeat VIA test in 3years (if test negativethen, every 5 years)Treat again withcryotherapyRefer to center or nearestfacility offering otherdiagnostic and treatmentoptionsCounsel again aboutadvantages anddisadvantages of alltreatment methods; referto nearest facility wheretreatment of choice isofferedREFERENCESAlliance for Cervical Cancer Prevention (ACCP). 2003. Effectiveness,Safety, and Acceptability of Cryotherapy: A Systematic LiteratureReview. Cervical Cancer Prevention Issues in Depth #1. ACCP.http://www.path.org/files/RH_cryo_white_paper.pdfAndersen ES and M Husth. 1992. Cryosurgery for cervical intraepithelialneoplasia: 10-year followup. Gynecological Oncology 45: 240–242.7-20 Cervical Cancer Prevention Guidelines for Low-Resource Settings