Cervical intraepithelial neoplasia (CIN) is a premalignant lesion that may exist at any one of three
stages: CIN1, CIN2, or CIN3. If left untreated, CIN2 or CIN3 (collectively referred to as CIN2+)
can progress to cervical cancer. Instead of screening and diagnosis by the standard sequence
of cytology, colposcopy, biopsy, and histological confirmation of CIN, an alternative method is to
use a ?screen-and-treat? approach in which the treatment decision is based on a screening test
and treatment is provided soon or, ideally, immediately after a positive screening test. Available
screening tests include a human papillomavirus (HPV) test, visual inspection with acetic acid
(VIA), and cytology (Pap test). Available treatments include cryotherapy, large loop excision of the
transformation zone (LEEP/LLETZ), and cold knife conization (CKC).
This guideline provides recommendations for strategies for a screen-and-treat programme. It
builds upon the existing WHO guidelines: Use of cryotherapy for cervical intraepithelial neoplasia
(published in 2011) and on the new WHO guidelines for treatment of cervical intraepithelial neoplasia
2?3 and glandular adenocarcinoma in situ (being published concomitantly with these present
guidelines). This guideline is intended primarily for policy-makers, managers, programme officers,
and other professionals in the health sector who have responsibility for choosing strategies for
cervical cancer prevention, at country, regional and district levels.
For countries where a cervical cancer prevention and control programme already exists, these
recommendations were developed to assist decision-makers to determine whether to provide a
different screening test followed by a different treatment, or to provide a series of tests followed
by an adequate treatment. For countries where such a programme does not currently exist, these
recommendations can be used to determine which screening test and treatment to provide. In
addition to the recommendations, a decision-making flowchart is also proposed in Annex 2 to help
programme managers choose the right strategy based on the specific country or regional context.
Once the strategy has been chosen, the appropriate screen-and-treat flowchart for that strategy
can be followed. The flowcharts for all strategies are provided in Annex 3 (specifically for women of
negative or unknown HIV status), and Annex 4 (for women of HIV-positive status or unknown HIV
status in areas with high endemic HIV infection).