Women in many developing countries in sub-Saharan Africa, south and south-east Asia, central and south America have a high risk of cervical cancer, and detection programmes and efficient screening programmes are largely lacking. The facilities, service delivery systems and expertise needed for detection and treatment of both cervical precancerous lesions and invasive cancers in many high-risk developing countries are very deficient. Thus, planned investments in health-care infrastructure and in equipping health care providers with skills in cervical cancer prevention are important components of global cervical cancer control initiatives.
Colposcopy is a diagnostic method useful for the diagnosis and evaluation of cervical intraepithelial neoplasia and preclinical invasive cancer. It allows magnified visualization of the site where cervical carcinogenesis occurs. It enables taking directed biopsy and in delineating the extent of lesions on the cervix in screen-positive women, thus avoiding conization. It also helps in directing treatments such as cryotherapy and loop electrosurgical excision procedure for cervical intraepithelial neoplasia. Colposcopy is not widely available and not widely practised in many developing countries where a high incidence of cervical cancer is observed. Similarly, skills and facilities for cryotherapy and loop electrosurgical excision procedure, the two appropriate treatment methods for cervical intraepithelial neoplasia in low-resource settings discussed in this manual, are extremely deficient in many developing countries at high risk for cervical cancer.
This introductory manual is intended to simplify the learning of colposcopy and treatment of cervical intraepithelial neoplasia with cryotherapy and loop electrosurgical excision procedure so as to allow dissemination of the skills in low-resource settings. The first draft of the manual was written as a result of an ICRETT fellowship, offered by the International Union Against Cancer (UICC). Subsequently, the manual was used in a number of training courses in developing countries to train health care personnel in colposcopy and treatment of cervical intraepithelial neoplasia, in the context of specific research and demonstration projects in early detection and prevention of cervical cancer. The feedback from those courses, and from users and the reviewers of draft versions of this manual, has been helpful to further improve the contents.
It is hoped that this manual will find a range of uses, as a resource for short teaching courses for health-care personnel, as a teaching, as well as a learning, aid for medical and nursing students, medical practitioners, as a field manual in screening programmes or even as a self-learning tool. Availability of simplified learning resources, training mechanisms and trained providers in cervical cancer prevention may help to overcome some of the technical challenges and may prepare the ground for implementing such services in developing countries. We believe that this manual will help to equip health care providers with the necessary skills in detecting and treating cervical intraepithelial neoplasia, thereby preventing invasive cervical cancer in many women world-wide.
P. Kleihues MD
C. Elias, M.D.