title: World Health Organization Guidelines for treatment of cervical intraepithelial neoplasia 2-3 and screen-and-treat strategies to prevent cervical cancer.
abstract: BACKGROUND
  It is estimated that 1%-2% of women develop cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) annually worldwide. The prevalence among women living with HIV is higher, at 10%. If left untreated, CIN 2-3 can progress to cervical cancer. WHO has previously published guidelines for strategies to screen and treat precancerous cervical lesions and for treatment of histologically confirmed CIN 2-3.
  
  
  METHODS
  Guidelines were developed using the WHO Handbook for Guideline Development and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. A multidisciplinary guideline panel was created. Systematic reviews of randomized controlled trials and observational studies were conducted. Evidence tables and Evidence to Recommendations Tables were prepared and presented to the panel.
  
  
  RESULTS
  There are nine recommendations for screen-and-treat strategies to prevent cervical cancer, including the HPV test, cytology, and visual inspection with acetic acid. There are seven for treatment of CIN with cryotherapy, loop electrosurgical excision procedure, and cold knife conization.
  
  
  CONCLUSIONS
  Recommendations have been produced on the basis of the best available evidence. However, high-quality evidence was not available. Such evidence is needed, in particular for screen-and-treat strategies that are relevant to low- and middle-income countries.
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors: Nancy
authors: N
authors: Santesso
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Departments of Internal Medicine/Nephrology and Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO, USA.
authors: Reem A
authors: RA
authors: Mustafa
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Electronic address: schuneh@mcmaster.ca.
authors: Holger J
authors: HJ
authors: Schünemann
authors: Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium.
authors: Marc
authors: M
authors: Arbyn
authors: Stanford University School of Medicine, Stanford, CA, USA.
authors: Paul D
authors: PD
authors: Blumenthal
authors: University of Massachusetts Medical School, Worcester, MA, USA.
authors: Joanna
authors: J
authors: Cain
authors: University of Zimbabwe, Harare, Zimbabwe.
authors: Michael
authors: M
authors: Chirenje
authors: University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
authors: Lynette
authors: L
authors: Denny
authors: International Agency for Research on Cancer, Lyon, France.
authors: Hugo
authors: H
authors: De Vuyst
authors: Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
authors: Linda O'Neal
authors: LO
authors: Eckert
authors: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Sara E
authors: SE
authors: Forhan
authors: McGill University, Montreal, QC, Canada.
authors: Eduardo L
authors: EL
authors: Franco
authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
authors: Julia C
authors: JC
authors: Gage
authors: American Cancer Society, Tucson, AZ, USA.
authors: Francisco
authors: F
authors: Garcia
authors: International Agency for Research on Cancer, Lyon, France.
authors: Rolando
authors: R
authors: Herrero
authors: PATH, Seattle, WA, USA.
authors: José
authors: J
authors: Jeronimo
authors: Jhpiego, Baltimore, MD, USA.
authors: Enriquito R
authors: ER
authors: Lu
authors: Cancer Prevention and Control PAHO, Washington, DC, USA.
authors: Silvana
authors: S
authors: Luciani
authors: KK Women's and Children's Hospital, Singapore, Singapore.
authors: Swee Chong
authors: SC
authors: Quek
authors: International Agency for Research on Cancer, Lyon, France.
authors: Rengaswamy
authors: R
authors: Sankaranarayanan
authors: PATH, Seattle, WA, USA.
authors: Vivien
authors: V
authors: Tsu
authors: Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors: Nathalie
authors: N
authors: Broutet
mesh_terms: D003127:Colposcopy; D019092:Conization; D003452:Cryosurgery; D017679:Cryotherapy; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D057240:Patient Preference; D016032:Randomized Controlled Trials as Topic; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D014944:World Health Organization; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000628:therapy*
keywords: Cervical cancer; Cervical intraepithelial neoplasia; Guidelines; Recommendations; Screen; Treat