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CERVICAL CANCER - PREVENTION & SCREENING
Mortality due to cervical cancer can be reduced by prevention, early detection & treatment.
Vaccination may be started as early as 9 years old.
Vaccination may reduce the incidence of HPV-related disease.
Screening for cervical cancer after vaccination is still recommended because only 70% of the virus types associated w/ invasive cervical cancer consist of HPV 16 & 18 types & women may not be entirely protected if they have been infected w/ other HPV types prior to vaccination.

Surgical Intervention

  • Choice of therapeutic option depends on patient’s age, parity, child-bearing desire, prior cytology and treatment history and history of follow-up, operator experience, and non-visualization of the transformation zone
  • Both modalities have similar efficacy with respect to eliminating cervical intraepithelial neoplasia (CIN) and decreasing the risk of developing invasive cervical cancer
    • Visual inspection with acetic acid (VIA)-positive women are treated with cryotherapy or, if ineligible, loop electrosurgical excision procedure (LEEP)
  • May have an adverse effect on future pregnancies
  •  Treatment failure rate has been varied from 1-25%, usually occurs within 2 years after treatment
  •  Patients treated for CIN 2/3 have an increased risk of developing invasive cervical cancer with 56 per 100,000 for at least 20 years post treatment; hence, follow-up is recommended

Ablative Methods

  • Eg Cryotherapy, laser ablation, electrofulguration, cold coagulation
    • Cryotherapy can be performed by trained and competent healthcare providers at all levels (eg doctors, nurses, midwives)

Excisional Methods

  • Eg Cold knife conization (CKC),LEEP/large loop excision of the transformation zone (LLETZ), laser conization, electrosurgical needle conization
    • Should only be performed by a trained health personnel (eg gynecologist)
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