Treatment of cervical intraepithelial neoplasia – Principles
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Cervical precancers are treated with either of the following techniques:
When the HPV test is used as a primary screening test in a screen-and-treat setting, all HPV-positive women are treated without further triage with VIA, cytology, or colposcopy. In a screen, triage, and treat setting, HPV-positive women are treated only when the triage test result is abnormal. In other settings (mostly higher-resource settings), women are treated after the diagnosis is confirmed to be CIN2 or CIN3 on histopathology. HPV-positive women with CIN1 may be followed up after 1 year and treated if there is persistence or progression of the lesion. These women may be treated immediately when follow-up cannot be ensured.
The choice of treatment (ablation or excision) depends on certain features of the cervix that can be visualized during examination after application of acetic acid for 1 minute.
The next section describes the selection criteria for ablative treatment and the steps to determine eligibility for ablative treatment.