See-and-treat strategy for diagnosis and management of cervical squamous intraepithelial lesions.
In a see-and-treat protocol, patients referred for colposcopy because of an abnormal Pap smear in cervical-cancer screening can be treated by loop excision, without biopsy, during one visit to the clinic. However, overtreatment in the see-and-treat strategy has been reported to be 1.2-83.3% for low-grade squamous intraepithelial lesions (SIL) and to be 13.3-83.3% for high-grade SIL. Range of overtreatment narrowed to 4.0-23.5% for those with normal pathology and to 18.0-29.4% for those with normal or low-grade pathology when calculation of overtreatment was restricted to patients diagnosed with high-grade SIL on colposcopy and referral Pap smear. Most common treatment complications are bleeding and infection. Nonetheless, the strategy has become accepted internationally: low costs, decreased patient anxiety, and increased compliance make it appealing, especially in settings with limited health resources, and for patients at risk of not being treated in a timely manner or of not returning for a second appointment. Mathematical modelling may give information about the appropriateness and usefulness of this treatment while the results of long-term clinical trials are awaited.
Cárdenas-Turanzas
Marylou
M
Section of Health Services Research, Department of Biostatistics and Applied Mathematics, University of Texas MD Anderson Cancer Center, Houston, Texas, TX 77030-4009, USA.
Follen
Michele
M
Benedet
John-Louis
JL
Cantor
Scott B
SB
D002986:Clinical Trials as Topic; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000628:therapy*