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WHO Guidelines for Treatment of Cervical Intraepithelial Neoplasia 2–3 and Adenocarcinoma in Situ

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WHO Guidelines for Treatment of Cervical Intraepithelial Neoplasia 2–3 and Adenocarcinoma in Situ WHO guidelines WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ Cryotherapy Large loop excision of the transformation zone Cold knife conization WHO guidelines WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ: cryotherapy, large loop excision of the transformation zone, and cold knife conization Catalogage à la source : Bibliothèque de l’OMS WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ: cryotherapy, large loop excision of the transformation zone, and cold knife conization. 1.Cervical Intraepithelial Neoplasia – diagnosis. 2.Cervical Intraepithelial Neoplasia – therapy. 3.Cervical Intraepithelial Neoplasia – surgery. 4.Adenocarcinoma – diagnosis. 5.Adenocarcinoma – therapy. 6.Cryotherapy – utilization. 7.Conization – methods. 8.Uterine Cervical Neoplasms – prevention and control. 9.Guideline. I.World Health Organization. ISBN 978 92 4 150677 9 (Classification NLM : WP 480) © World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Switzerland Contents Lists of participants v Process for managing declarations and conflicts of interest ix Acknowledgements x Acronyms and abbreviations xi Executive summary xii Summary treatment recommendations xiii 1. Introduction 1 Target audience 1 Purpose 1 2. Methods 3 3. Recommendations 7 4. Research gaps and further considerations 11 5. Use of the guideline 12 Guideline dissemination 12 Guideline evaluation 12 Guideline update 13 References 14 Annexes Annex 1: Declarations of interest 16 Annex 2: Search strategies for evidence reviews 19 Annex 3: PRISMA flow diagram for inclusion and exclusion of studies for evidence reviews 20 Annex 4: List of references for studies included in evidence reviews 22 Supplemental material: GRADE evidence-to-recommendation tables and evidence profiles for each recommendation* * Available online: www.who.int/reproductivehealth/publications/cancers/treatment_CIN_2-3/en/index.html WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ v Lists of participants WHO Steering Group Adriana Velazquez Essential Medicines and Pharmaceutical Nathalie Broutet (Lead) Policies Reproductive Health and Research WHO Headquarters WHO Headquarters Marco Vitoria Jean-Marie Dangou HIV Treatment and Care Disease Prevention and Control WHO Headquarters WHO Regional Office for Africa Lawrence Von Karsa Ibtihal Fadhil Quality Assurance and Screening Noncommunicable Diseases International Agency for Research on Cancer WHO Regional Office for the Eastern Mediterranean Guideline Development Group Gunta Lazdane Marc Arbyn Sexual and Reproductive Health Unit of Cancer Epidemiology WHO Regional Office for Europe Scientific Institute of Public Health – Louis Pasteur Silvana Luciani Brussels, Belgium Cancer Prevention and Control WHO Regional Office for the Americas / Paul D. Blumenthal Pan American Health Organization (PAHO) Population Services International (PSI) Stanford University School of Medicine Arvind Mathur Department of Obstetrics and Gynecology Making Pregnancy Safer and Reproductive Stanford, USA Health WHO Regional Office for South-East Asia Joanna Cain (Chair) International Federation of Gynecology and Amolo Okero Obstetrics (FIGO) Counselling and Testing, HIV/AIDS London, United Kingdom WHO Headquarters Michael Chirenje Somchai Peerapakorn Department Obstetrics and Gynaecology Reproductive Health University of Zimbabwe Medical School WHO Country Office – Thailand Harare, Zimbabwe Andreas Ullrich Lynette Denny Chronic Diseases Prevention and Management Department Obstetrics and Gynaecology WHO Headquarters Groote Schuur Hospital Cape Town, South Africa Cherian Varghese Noncommunicable Diseases and Health Hugo De Vuyst Promotion Infections and Cancer Epidemiology WHO Regional Office for the Western Pacific International Agency for Research on Cancer Lyon, France vi WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ Linda O'Neal Eckert Rengaswamy Sankaranarayanan Department of Global Health Prevention and Implementation Group Gynecology Director International Agency for Research on Cancer Harborview Center for Sexual Assault and Lyon, France Traumatic Stress Seattle, USA Vivien Tsu PATH Sara Forhan Seattle, USA HIV Care and Treatment Branch Global AIDS Program Methods Group Centers for Disease Control and Prevention (CDC) Atlanta, USA Based at MacGRADE Collaborating Centre, McMaster University, Hamilton, Canada: Eduardo Franco systematic review team and GRADE Division of Cancer Epidemiology methodologists McGill University Montreal QC, Canada Holger Schünemann (Lead Investigator) Department of Clinical Epidemiology and Julia C. Gage Biostatistics Division of Cancer Epidemiology and Genetics National Cancer Institute Reem A. Mustafa (Coordinator) Rockville, USA Department of Clinical Epidemiology and Biostatistics Francisco Garcia American Cancer Society Nancy Santesso (Coordinator) Tucson, USA Department of Clinical Epidemiology and Biostatistics Rolando Herrero Prevention and Implementation Group External Review Group International Agency for Research on Cancer Lyon, France Irene Agurto Santiago, Chile José Jeronimo PATH Ahti Anttila Seattle, USA Mass Screening Registry Finnish Cancer Registry Enriquito R. Lu Helsinki, Finland Jhpiego Baltimore, USA Partha Sarathi Basu Department of Gynecologic Oncology Silvana Luciani Chittaranjan National Cancer Institute Cancer Prevention and Control Kolkata, India PAHO Washington DC, USA John-Paul Bogers Laboratorium voor Cel – en Weefselleer Swee Chong Quek Faculteit Geneeskunde Women's and Children's Hospital Campus Groenenborger Singapore Antwerp, Belgium WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ vii August Burns Ian Magrath Grounds for Health International Network for Cancer Treatment and Waterbury, USA Research Brussels, Belgium Rolando Camacho-Rodriguez Cancer Control Coordinator Raul Murillo Programme of Action for Cancer Therapy Subdireccion Investigaciones y Salud Pública International Atomic Energy Agency Instituto Nacional de Cancerología de Colombia Vienna, Austria Bogotá, Colombia Silvia de Sanjosé Daniel Murokora Institut Català d'Oncologia Uganda Women's Health Initiative L'Hospitalet de Llobregat Kampala, Uganda Barcelona, Spain Oneko Olola Anne Garnier Kilimanjaro Christian Medical Centre Department of Cancer Screening Moshi, Tanzania Institut National du Cancer (INCa) Boulogne-Billancourt, France Groesbeck Parham Centre for Infectious Disease Research in Martha Jacob Zambia Kochi Lusaka, Zambia Kerala State, India Patrick Petignat Namory Keita Surgical Gynecologic Oncology Unit Department of Gynecology and Obstetrics Hôpital Cantonal Donka Teaching Hospital Geneva, Switzerland Conakry, Republic of Guinea Ilka Rondinelli Nancy Kidula International Planned Parenthood Federation ACCESS Uzima, Jhpiego London, United Kingdom Nairobi, Kenya Carlos Santos Rajshree Jha Kumar Instituto Nacional de Enfermedades Mumbai, India Neoplásicas Lima, Peru Anne Levin Bethesda, USA Mona Saraiya Division of Cancer Prevention and Control Khunying Kobchitt Limpaphayom National Center for Chronic Disease Prevention Department of Obstetrics and Gynecology and Health Faculty of Medicine CDC Chulalongkorn University Atlanta, USA Bangkok, Thailand viii WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ Achim Schneider Jérôme Viguier Klinik für Gynäkologie und Gynäkologische Santé Publique Onkologie INCa CharitéCentrum Boulogne-Billancourt, France Berlin, Germany Steven Weyers Nereo Segnan Department of Obstetrics and Gynecology Department of Cancer Screening Ghent University Hospital and Unit of Cancer Epidemiology Gent,
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