Screening and management of preinvasive lesions of the cervix: Good clinical practice recommendations from the Federation of Obstetrics and Gynaecologic Societies of India (FOGSI)

Abstract

In India, there are marked variations in resources for cervical cancer screening. For the first time, resourcestratified screening guidelines have been developed that will be suitable for low middle-income countries with similar diversities. The current article describes the process and outcomes of these resource stratified guidelines for screening and treatment of preinvasive lesions of cervix. Evidence from literature was collated and various guidelines were reviewed by an expert panel. Based on the level of evidence, guidelines were developed for screening by human papillomavirus (HPV) testing, cytology and visual inspection after application of acetic acid (VIA), and management of screen positive lesions in different resource settings. Expert opinion was used for certain country-specific situations. The healthcare system was stratified into two resource settingsgood or limited. The mode of screening and treatment for each was described. HPV testing is the preferred method for cervical cancer screening. VIA by trained providers is especially suitable for low resource settings until an affordable HPV test becomes available. Healthcare providers can choose the most appropriate screening and treatment modality. A single visit approach is encouraged and treatment may be offered based on colposcopy diagnosis ('see and treat') or even on the basis of HPV test or VIA results ('screen and treat'), if compliance cannot be ensured. The Federation of Obsterician and Gynaecologists of India Good Clinical Practice Recommendations (FOGSI) GCPR are appropriately designed for countries with varied resource situations to ensure an acceptable cervical cancer prevention strategy.The three main modalities of screening in use are HPV testing, cytology and visual inspection with 202

Cervical Cancer Prevention Efforts in India

“…The NPCDCS guidelines published in 2016 have adopted VIA as the test of choice in screening programmes, with 5-yearly screening among women aged 30–65 years, along with screening for breast and oral cancer. FOGSI also recommends VIA as the test of choice in limited resource settings [ 16 ].…”

“…The Indian Academy of Paediatrics Committee on Immunisation (IAPCOI) recommends it for all females starting from 9 years of age. FOGSI recommends 9–14 years as the ideal time for vaccination, with vaccination of older age cohorts to be considered with an understanding that vaccination in sexually active females may be less effective as they may already be infected, but may provide some benefit against the types to which they have not been exposed earlier [ 16 ].…”

Cervical cancer screening using liquid-based cytology (LBC) in a secondary care hospital in Northeast India

“…For screening, triaging and management of cases, the federation recommends exercising the most optimum approach according to resource availability and comprehensive follow-up and treatment. 12 Cervical cancer is one of the preventable cancers and when diagnosed early is one of the most successfully treatable forms of cancer. 13 The current statistics designates a long term medical negligence which warrants immediate interventions for eliminating this disease burden.…”

Human papillomavirus vaccination: Good clinical practice recommendations from the Federation of Obstetric and Gynecological Societies of India

“…The methodology for the formulation of guidelines has been previously described. 8 A detailed review of available literature was done with reference to recipients' age, vaccine-type used, different doses and dosing schedules. Outcomes in terms of immunogenicity and efficacy of different doses and vaccine-types were evaluated.…”