title: Clinical Practice Guidelines on the Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention in Saudi Arabia.
abstract: BACKGROUND
  Cervical cancer is the third most common gynecological malignancy in Saudi women with an estimated incidence rate of 1.9 cases per 100 000 women-years. More than 40% of cervical cancer cases are diagnosed at advanced stages due to lack of a routine screening program in Saudi Arabia. Thus, national guidelines for routine screening and treatment of precancerous cervical lesions are needed.
  
  
  METHODS
  The Saudi Centre for Evidence-Based Healthcare invited a panel of local experts and partnered them with a team from McMaster University in Canada for methodological support, to develop national clinical practice guidelines on the screening and treatment of precancerous lesions for cervical cancer. After the panel identified key clinical questions, the McMaster University working group updated existing systematic reviews that had been used for the 2013 WHO Guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Recommendations were based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. Those recommendations took into account the available evidence, patient values and preferences, and resource use in the Saudi context. The panel provided recommendations on two major issues: screening for precancerous lesions (cervical intraepithelial neoplasia 2 & 3) and treatment of those lesions to prevent cervical cancer in women who tested positive after screening.
  
  
  CONCLUSIONS
  The Saudi expert panel recommends using the HPV DNA test followed by colposcopy or cytology (Pap test) followed by colposcopy to screen for CIN2+ in women at risk of cervical cancer. The panel recommends cryotherapy or loop excision electrosurgery procedure (LEEP) over cold knife cone biopsy to treat women at risk of cervical cancer that tests positive for CIN2+. Universal screening for precancerous cervical dysplasia in women in Saudi Arabia is recommended using HPV testing and or cytology. Either cryotherapy or LEEP are preferred for treatment.
  
  
  CONCLUSIONS
  National studies on cervical cancer screening modalities and treatment of precancerous cervical lesions, including HPV prevalence and its association with cervical cancer, are scarce.
authors.affiliation: Hazem Mahmoud Al-Mandeel,, Associate Professor, King Khalid University Hospital,, Obstetrics and Gynecology,, College of Medicine and King Saud Medical University, Medical City,, King Saud University,, PO Box 7805, Riyadh 11472,, Saudi Arabia, T: +966-11-469-1775, F: +966-11-467-9557, hmmandeel@yahoo.ca, ORCID ID: http://orcid.org/0000-0002-2329-0288.
authors.forename: Hazem Mahmoud
authors.initials: HM
authors.lastname: Al-Mandeel
authors.forename: Emad
authors.initials: E
authors.lastname: Sagr
authors.forename: Khalid
authors.initials: K
authors.lastname: Sait
authors.forename: Hassan Mohamed
authors.initials: HM
authors.lastname: Latifah
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Al-Obaid
authors.forename: Ismail A
authors.initials: IA
authors.lastname: Al-Badawi
authors.forename: Abdulmohsen O
authors.initials: AO
authors.lastname: Alkushi
authors.forename: Hany
authors.initials: H
authors.lastname: Salem
authors.forename: Nada S
authors.initials: NS
authors.lastname: Massoudi
authors.forename: Holger
authors.initials: H
authors.lastname: Schunemann
authors.forename: Reem A
authors.initials: RA
authors.lastname: Mustafa
authors.forename: Romina
authors.initials: R
authors.lastname: Brignardello-Petersen
mesh_terms: D003127:Colposcopy; D017679:Cryotherapy; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D004598:Electrosurgery; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis*; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000601:surgery; D012529:Saudi Arabia; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000601:surgery