Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia

Santesso, Nancy; Mustafa, Reem A.; Wiercioch, Wojtek; Kehar, Rohan; Gandhi, Shreyas; Chen, Yaolong; Cheung, Adrienne; Hopkins, Jessica; Khatib, Rasha; Ma, Bin; Mustafa, Ahmad; Lloyd, Nancy; Wu, Darong; Broutet, Nathalie; Schünemann, Holger J.

doi:10.1016/j.ijgo.2015.07.026

Cited by 169 publications

(142 citation statements)

References 29 publications

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“…For this analysis, we reasonably assumed (approximated) that all CIN3/AIS was successfully treated, given the efficacy of excisional treatments to treat CIN3/AIS [22]. We also calculated diagnostic yield, precancers per 1,000 cotests or precancers and cancers per 1,000 cotests, as surrogate measure of programmatic efficiency.…”

Section: Methodsmentioning

confidence: 99%

Why does cervical cancer occur in a state-of-the-art screening program?

Castle

Kinney

Cheung

et al. 2017

Gynecologic Oncology

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Background The goal of cervical screening is to detect and treat precancers before some become cancer. We wanted to understand why, despite state-of-the-art methods, cervical cancers occur related to programmatic performance at Kaiser Permanente Northern California (KPNC), where >1,000,000 women aged ≥30 years have undergone cervical cancer screening by triennial HPV and cytology cotesting since 2003. Methods We reviewed clinical histories preceding cervical cancer diagnoses to assign “causes” of cancer. We calculated surrogate measures of programmatic effectiveness (precancers/(precancers and cancers)) and diagnostic yield (precancers and cancers per 1,000 cotests), overall and by age at cotest (30–39, 40–49, and ≥50 years). Results Cancer was rare and found mainly in a localized (treatable) stage. Of 623 cervical cancers with at least one preceding or concurrent cotest, 360 (57.8%) were judged to be prevalent (diagnosed at a localized stage within one year or regional/distant stage within two years of the first cotest). Non-compliance with recommended screening and management preceded 9.0% of all cancers. False-negative cotests/sampling errors (HPV and cytology negative), false-negative histologic diagnoses, and treatment failures preceded 11.2%, 9.0%, and 4.3%, respectively, of all cancers. There was significant heterogeneity in the causes of cancer by histologic category (p<0.001 for all; p=0.002 excluding prevalent cases). Programmatic effectiveness (95.3%) and diagnostic yield were greater for squamous cell versus adenocarcinoma histology (p<0.0001) and both decreased with older ages (ptrend<0.0001). Conclusions A state-of-the-art intensive screening program results in very few cervical cancers, most of which are detected early by screening. Screening may become less efficient at older ages.

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Section: Methodsmentioning

confidence: 99%

Why does cervical cancer occur in a state-of-the-art screening program?

Castle

Kinney

Cheung

et al. 2017

Gynecologic Oncology

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“…[46] Furthermore, a meta-analysis reported that 14.8% (65/439) of the women treated with cryotherapy had infertility and 12 reported spontaneous abortions in 210 pregnancies. [51] Scaling-up programs will require planners to keep in mind that if diagnostic services are provided at the screening site, fewer women would need to be referred, thereby reducing loss to follow-up. In waiting for diagnostic confirmation, this model also prevents overtreatment by cryotherapy, which has been reported in the ‘screen and treat’ model.…”

Section: Discussionmentioning

confidence: 99%

Implementing community-based cervical cancer screening programs using visual inspection with acetic acid in India: A systematic review

Adsul

Manjunath

Srinivas

et al. 2017

Cancer Epidemiology

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The objective of this review was to systematically appraise the existing published literature about community-based cervical cancer screening programs that have used visual inspection methods using acetic acid (VIA) in India. All peer reviewed journal articles till December 2015 were searched per PRISMA guidelines. Articles reporting results from cervical cancer screening programs in community-based settings, conducted in India, and using VIA were included in this review. The search resulted in 20 articles to be included in the review with a total of 313,553 women at 12 unique urban and rural sites across India. Seventeen (85%) studies were cross-sectional and three studies were randomized controlled trials; most studies compared accuracy of VIA with other screening tests such as visual inspection using Lugol’s Iodine (VILI), HPV DNA, and cytology. Of studies that reported test accuracy for CIN Grade 2+, the VIA sensitivity values ranged from 16.6 – 82.6% and specificity ranged from 82.1 – 96.8%. Women between age groups of 30–59 years were recruited using motivational one-on-one counseling and local support staff. All studies conducted diagnostic follow-up using colposcopy and guided biopsies, when necessary. Three major themes were identified that facilitated implementation of screening programs in a community-based setting: standardized training that maintained competency of test providers; collaborations with community-based organizations that used health education for recruitment of participants; and employing the screen-and-treat method to reduce loss to follow-up. Summarized evidence presented in this review could substantially influence future implementation and sustainment of cervical cancer screening programs at a national level.

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“…Assessment of the pathological diagnosis was conducted as blindness by a single experienced pathologist at baseline and after the 6-month intervention. Previous studies have reported that compared with other treating methods (cryotherapy and cold knife conization), LEEP is the main treatment modality of CIN2/3 [12-13], and colposcopy and cervical biopsy are the accepted diagnostic tests of CIN [13]. …”

Section: Methodsmentioning

confidence: 99%

Long-Term Vitamin D Supplementation and the Effects on Recurrence and Metabolic Status of Cervical Intraepithelial Neoplasia Grade 2 or 3: A Randomized, Double-Blind, Placebo-Controlled Trial

et al. 2018

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Objective: This study was conducted to evaluate the effects of vitamin D supplementation on the recurrence and metabolic status of patients with cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3). Methods: This randomized, double-blind, placebo-controlled trial was carried out among 58 women diagnosed with CIN2/3. Participants were randomly assigned into 2 groups to receive either 50,000 IU vitamin D3 (n = 29) or placebo (n = 29) every 2 weeks for 6 months. Results: The recurrence rate of CIN1/2/3 was 18.5 and 48.1% in the vitamin D and placebo groups respectively (p = 0.02). When we excluded CIN1, the recurrence rate of CIN2/3 became nonsignificant. Vitamin D supplementation significantly decreased fasting plasma glucose (–7.8 ± 9.2 vs. –1.1 ± 8.6 mg/dL, p = 0.006) and insulin levels (–3.2 ± 4.8 vs. –0.9 ± 3.4 µIU/mL, p = 0.03), and significantly increased quantitative insulin sensitivity check index (0.01 ± 0.02 vs. 0.002 ± 0.01, p = 0.02) compared with the placebo. Additionally, there was a significant decrease in high-sensitivity C-reactive protein (–815.3 ± 1,786.2 vs. 717.5 ± 1,827.3 ng/mL, p = 0.002) and a significant increase in total antioxidant capacity (113.4 ± 137.4 vs. –53.7 ± 186.7 mmol/L, p < 0.001) following the supplementation of vitamin D compared with the placebo. Conclusions: Vitamin D3 supplementation for 6 months among women with CIN2/3 had beneficial effects on CIN1/2/3 recurrence and metabolic status; however, it did not affect CIN2/3 recurrence.

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Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia

Abstract: Despite a comprehensive search, there is very low quality evidence and often no evidence for important outcomes, including reproductive outcomes and complications. Studies assessing these outcomes are needed.

Cited by 169 publications

References 29 publications

Why does cervical cancer occur in a state-of-the-art screening program?

Why does cervical cancer occur in a state-of-the-art screening program?

Implementing community-based cervical cancer screening programs using visual inspection with acetic acid in India: A systematic review

Long-Term Vitamin D Supplementation and the Effects on Recurrence and Metabolic Status of Cervical Intraepithelial Neoplasia Grade 2 or 3: A Randomized, Double-Blind, Placebo-Controlled Trial

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