1. ¹Screening Group, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France
2. ²Preventive Medicine Department, PSG Medical College, Coimbatore, 641004 Tamil Nadu, India
3. ³Department of Radiotherapy, Christian Fellowship Community Health Centre, Ambillikai, Dindigul District, Tamil Nadu 624612, India
4. ⁴Department of Pathology, PSG Institute of Medical Sciences and Research, Coimbatore 641 004, Tamil Nadu, India
5. ⁵Laboratoire d'Anatomie et de Cytologie Pathologiques, Hôpital Edouard Herriot, Lyon 69003, France
6. ⁶Department of Pathology, Regional Cancer Centre, Medical College Campus, Trivandrum, Kerala 695011, India

Correspondence: Dr R Sankaranarayanan, Screening Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon cedex 08, France. E-mail: sankar@iarc.fr

Received 27 November 2006; Accepted 20 January 2007; Published online 20 February 2007.

Abstract

We evaluated a 'see and treat' procedure involving screening, colposcopy, biopsy and cryotherapy by trained nurses in one-visit in field clinics in a cervical screening study in South India for its acceptability, safety and effectiveness in curing cervical intraepithelial neoplasia (CIN). Women positive on visual inspection with acetic acid (VIA) were advised colposcopy, directed biopsies and cryotherapy if they had colposcopic impression of CIN in one visit by nurses in field clinics supervised by a doctor. Side effects and complications were assessed and cure rates were evaluated with VIA, colposcopy and biopsy if colposcopic abnormalities were suspected. Cure was defined as no clinical or histological evidence of CIN at 6 months from treatment. Of the 2513 women offered 'see and treat' procedure, 1879 (74.8%) accepted. Of the 1397 women with histologically proved CIN treated with cryotherapy, 1026 reported for follow-up evaluation. Cure rates were 81.4% (752 out of 924) for women with CIN 1; 71.4% (55 out of 77) for CIN 2 and 68.0% (17 out of 25) for CIN 3. Minor side effects and complications were documented in less than 3% of women. 'See and treat' with cryotherapy by nurses under medical supervision is acceptable, safe and effective for cervical cancer prevention in low-resource settings.