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Int J Gynaecol Obstet. 2017 Jul;138 Suppl 1:26-32. doi: 10.1002/ijgo.12183.

Management algorithms for cervical cancer screening and precancer treatment for resource-limited settings.

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Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
Lalla Salma Foundation for Cancer Prevention and Treatment, Rabat, Morocco.
Division of Clinical Oncology, National Institute of Cancer Prevention and Research (ICMR), Noida, India.
Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.


Management algorithms for screen-positive women in cervical cancer prevention programs have undergone substantial changes in recent years. The WHO strongly recommends human papillomavirus (HPV) testing for primary screening, if affordable, or if not, then visual inspection with acetic acid (VIA), and promotes treatment directly following screening through the screen-and-treat approach (one or two clinic visits). While VIA-positive women can be offered immediate ablative treatment based on certain eligibility criteria, HPV-positive women need to undergo subsequent VIA to determine their eligibility. Simpler ablative methods of treatment such as cryotherapy and thermal coagulation have been demonstrated to be effective and to have excellent safety profiles, and these have become integral parts of new management algorithms. The challenges faced by low-resource countries are many and include, from the management perspective, identifying an affordable point-of-care HPV detection test, minimizing over-treatment, and installing an effective information system to ensure high compliance to treatment and follow-up.


Cervical cancer; Low-resource setting; Management algorithms; Positive screening test; Screen and treat; Triaging

[Indexed for MEDLINE]

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