Treatment 

Any screening program must be accompanied by adequate treatment options. In many countries, treatment options are limited; pre-invasive cervical lesions often are treated with aggressive approaches such as cone biopsy or hysterectomy rather than with more appropriate, outpatient approaches. Although appropriate for certain circumstances, inpatient approaches are expensive and often result in over-treatment of women. In addition, they can result in serious complications and side effects, and require significant resources for anesthesia, equipment, and inpatient care. 

Relatively simple outpatient procedures can be used to destroy or remove precancerous tissue (see Table 2). The specific treatment used depends on the severity, size, and location of the lesion. A common outpatient ablation (destruction) method is cryotherapy, which involves freezing abnormal tissue with a probe cooled by liquid nitrous oxide or carbon dioxide. Cryotherapy has an overall effectiveness rate of 80 to 90 percent; it is most effective with smaller areas of abnormal tissue.22 Another outpatient excisional method is loop electrosurgical excision procedure (LEEP). Although LEEP involves more equipment and supplies, it removes diseased tissue and provides a tissue sample for analysis, reducing the possibility of overlooking invasive cancer. A 1998 study comparing cryotherapy, LEEP, and laser vaporization found the three methods to be equally safe and effective.23 

Some developed-country programs have begun to adopt a “see and treat” approach to treating pre-invasive lesions, in which LEEP is used to remove tissue for diagnosis and treatment immediately following colposcopic diagnosis. This approach reduces the number of visits a woman must make to receive proper care—a clear advantage in many settings. It may result in some over-treatment, however. Also, concern remains that the possible sequelae of treatment—bleeding, discharge, and cervical scarring—need to be better defined. Projects in
Thailand and South Africa are evaluating the safety, acceptability, feasibility, and program effectiveness of a see-and-treat approach—VIA followed immediately by cryotherapy as appropriate.24