title: Screening for and management of high-grade cervical intraepithelial neoplasia in Bangladesh: a cross-sectional study comparing two protocols.
abstract: OBJECTIVE
  To evaluate the feasibility of the 'see and treat' protocol for the management of high-grade cervical intraepithelial neoplasia (CIN) at a colposcopy clinic in Bangladesh.
  
  
  METHODS
  A cross-sectional and comparative study was carried out between two periods on 358 colposcopy-diagnosed high-grade CIN at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU). During the first period (January 2005 to June 2008), 181 colposcopy-diagnosed high-grade CIN patients had cervical biopsy by punch biopsy forceps and histology-confirmed high-grade CIN were treated by loop electrosurgical excision procedure (LEEP). During the second period (July 2008 to December 2009), 177 colposcopy-diagnosed high-grade CIN were treated by LEEP at their first visit.
  
  
  RESULTS
  During the first and second periods, 48 of 87 and 55 of 73 histology-proven high-grade CIN cases, respectively, received treatment. Among the study population, 37.3% women who had normal or CIN-I in histology were treated unnecessarily in the second period. The compliance of treatment improved by 20% and failure to receive treatment fell by 20%; these changes were statistically significant (P=0.006).
  
  
  CONCLUSIONS
  'See and treat' protocol is a well-accepted, feasible and useful option for management of high-grade CIN in Bangladesh. It reduces the number of visits to the clinic and failure to receive treatment.
authors.affiliation: Department of Obstetrics and Gynaecology, Gynaecological Oncology Unit, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. ashra58@yahoo.co.uk
authors.forename: Ashrafun
authors.initials: A
authors.lastname: Nessa
authors.forename: Mohammad Harun Ur
authors.initials: MH
authors.lastname: Rashid
authors.forename: Noor
authors.initials: N
authors.lastname: E-Ferdous
authors.forename: Afroza
authors.initials: A
authors.lastname: Chowdhury
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003906:Developing Countries; D055088:Early Detection of Cancer / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006295:Health Resources; D006801:Humans; D060787:Neoplasm Grading; D010349:Patient Compliance; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy