Reference Manual - IARC Screening Group

IntroductionCompared to other methods of treatment, it is relatively easy to traindifferent cadres of healthcare providers to use cryotherapy (Blumenthalet al. 2005). This advantage, combined with its low cost and high efficacyrate, make it appropriate for low-resource settings where only nurses ornurse-midwives are posted.MANAGING PRECANCEROUS CERVICAL DISEASEIn developed countries, to reduce the number of times a woman needs tovisit the clinic, many screening programs have adopted a “see-and-treat”approach to managing precancerous cervical lesions. A screen-and-treatapproach means that after receiving a positive Pap smear result, a womanhas a colposcopic examination and, if colposcopically indicated, isimmediately offered treatment with LEEP without waiting for histologicconfirmation.The management approach described in this manual uses a modifiedversion of the screen-and-treat approach. This “single visit” approachlinks VIA with treatment using cryotherapy. Using this approach, womenwith VIA-positive results and for whom cryotherapy is indicated areoffered treatment. The main advantage of this approach is that it reducesthe number of women who are lost to followup. This loss often occurswhen women have to return to the clinic for the screening test results,diagnostic followup and possible treatment.In addition, performing VIA and cryotherapy during the same visit canoccur at the lowest level of the healthcare system, where the majority ofat-risk women will go at least once in their lives. Given that thehealthcare providers most often posted to such low-level facilities arenurses or nurse-midwives, this approach assumes that both testing andtreatment can be performed competently by these or similar cadres ofhealthcare personnel. The disadvantage of the screen-and-treat approachis that because VIA has a considerable false-positive rate, a proportion ofwomen who are VIA-positive do not have precancerous lesions. Thelower the prevalence of disease in the population being screened, thehigher the number of women with false positive results who may agree toreceiving treatment immediately after VIA.As of 2004, there is now one study with published results from a projectusing the single visit approach in conjunction with VIA.Cervical Cancer Prevention Guidelines for Low-Resource Settings 1-13