See-and-Treat Approach to Cervical Intraepithelial Lesions in HRH Princess Maha Chakri Sirindhorn Medical Center

Abstract

Background: To evaluate the overtreatment rate with the see and treat approach in the management of women with abnormal cervical cytology. Materials and Methods: A retrospective review of patients with abnormal cervical cytology who underwent S&T at MSMC between January 2008 and December 2012 was conducted. Loop electrosurgical excision procedure (LEEP), histological results, cytology and colposcopic impression were analyzed to evaluate overtreatment rate, cyto-histologic correlation and related factors. Results: Average age of S&T cases was 42 years. Ninety seven percents were referred from affiliated health care providers. The study revealed 83.2% patients had HSIL or higher from cervical cytology. Correlation between HSIL and final histology was relatively low at 75% compared to other studies. Overtreatment rate was 28%. Conclusions: S&T was done in 197 patients in a tertiary care health facility with patient satisfaction. Overtreatment occurred, but the rate can be reduced with appropriate recommendations. HSIL Pap smears should be reexamined before S&T while low grade and lesser colposcopic impression groups should obtain conventional colposcopic approach for patient future reproductive benefit.

Overtreatment and Cost-Effectiveness of the See-and-Treat Strategy for Managing Cervical Precancer

“…With this type of analysis, influential variable values, including treatment compliance, are drawn from a distribution of possible values. These indiscriminating results are thus indicative of a wide range of reported patient compliance levels (2, 20, 21, 26) and estimates of the overtreatment rate (5, 7, 27). …”

“…However, as reducing the burden of cervical cancer in lower-resource settings has taken greater priority in recent years, a see-and-treat strategy may be feasible where treatment compliance is low (5, 32). Despite the overtreatment rate, this approach has been accepted for underserved communities internationally (2, 5, 26, 27, 33, 34). Nevertheless, our study findings are based on a U.S. framework and cannot be directly applied to additional settings without determining the epidemiology of cervical cancer and its management in a particular population.…”

“Three-Step Approach” Versus “See-and-Treat Procedure” in women with “High Grade Squamous Intraepithelial Lesion” (HSIL) or “Atypical Squamous Cells cannot exclude HSIL” (ASC-H) Cytology

“…Using the "See-and-Treat strategy, we found 22.9% and 48.6% overtreatment rate in HSIL group and ASC-H group, respectively. In previous studies the overtreatment rates in HSIL cytology range from 3.0% to as much as 39.4% (7,19,20).…”

“…Because of discordance between different authors, Srisuwan et al suggested to review cytology reports by a second opinion before management to decrease the overtreatment rate (20). It is also known that narrowing the screening interval increases the risk of unnecessary treatment (14).…”

Preliminary Evaluation of the in vitro Efficacy of 1, 2-di (Quinazolin-4-yl) Diselane against SiHa Cervical Cancer Cells

“…Cervical cancer is one the most common malignancy among females, and common age group of patients is 45-55 year (Srisuwan et al, 2014). There are several risk factors including Human papillomavirus (HPV), smoking, the interval between menarche and first sexual intercourse (Natphopsuk et al, 2012).…”