Screening and Treatment of Precancerous Lesions

Early Detection and Treatment of Precancerous Lesions is Critical to Prevent the Progression of Cervical Cancer

Cervical cancer develops slowly over many years, even decades, often without symptoms.

Screening with high-performance tests of all women between the ages of 30-49 years provides the best opportunity to find precancerous lesions and treat them before they have the chance to progress into cancer.

Most women have healthy cervixes, but it is still extremely important that all women are screened at least twice to ensure they do not have any lesions.

Women who have precancerous lesions or lesions suspicious for cancer must receive timely treatment to prevent progression to cancer.

Early detection and prompt treatment of precancerous lesions are crucial to driving down incidence of cervical cancer.

Screening Overview

Screening is the term used for a routine cervical health check of women to see if they are at risk of developing cervical cancer. Cervical cancer develops slowly, after many years of persistent infection with the Human Papillomavirus (HPV). Cervical precancers are not cancer but are lesions may develop into cancer if left unidentified and untreated. Precancerous lesions on the cervix can be found by taking a swab of the cervix and testing it for the presence of HPV (HPV testing), or by taking a smear and looking for cell abnormalities (a Pap smear). The recommended screening method is HPV DNA testing, but other methods include visual inspection with acetic acid (VIA), Pap smear, or a combination of these.

Fortunately, it is possible to prevent precancerous lesions from progressing to cervical cancer by detecting and treating them. In most cases, early precancerous lesions can be quickly and safely treated with thermal ablation or cryotherapy. WHO supports screen-and-treat approaches for early precancerous lesions, where women can be screened, and if necessary, treated in a single visit. For more developed lesions, and in some other cases, a Loop Electrosurgical Excision Procedure (LEEP) may be needed. While thermal ablation and cryotherapy treatments can be conducted in local clinical settings, LEEP treatments are usually only available in district or regional hospitals.

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The long time period between first getting an HPV infection and the development of cervical cancer presents an opportunity to prevent cervical cancer in women by identifying and treating these precancers before they become cancer. However, because women with cervical precancers and early cancers usually have no symptoms, screening must be done routinely. The WHO recommends that all women should be screened with high-performance tests at least twice between the ages of 30 and 49. Due to their increased risk of developing cervical cancer, and the quickened progression of pre-cancerous lesions into cancer, women living with HIV should be screened annually.

There are reasonably priced, safe, and effective screening and treatment solutions for all contexts and resources; but we must work together to increase coverage, ensure access, ensure affordability, and increase uptake. All women should have access to screening and treatment, wherever they are.

Since women living with HIV are 5-6 times more likely to develop cervical cancer, the integration of screening and treatment with other relevant health services is particularly important. By strengthening integrations across the health system— with HIV/AIDS, but also non-communicable diseases (NCDs), and sexual and reproductive health and rights (SHRH)—we can maximize efficiencies at the community health level and improve referral systems to ensure timely treatment. Early detection and prompt treatment of precancerous lesions are crucial to driving down incidence and mortality rates of cervical cancer. Ensuring all women get screened routinely will be crucial for achieving a world free of cervical cancer.

Action for Elimination

Cervical screening helps detect precancerous lesions that may lead to cancer, as well as detect early-stage cancer when it can be more readily treated. Early detection, diagnosis, and prompt treatment of precancerous lesions are crucial to driving down incidence in the next decades by preventing the development of cervical cancer. But for too many, it remains out of reach.

Action for Elimination
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In many countries, coverage, access to, and support for the uptake of systematic screening and treatment of precancerous lesions remains low, resulting in too many women being diagnosed in advanced stages when prevention is no longer an option and treatment may be difficult.

In low- and middle-income countries (LMICs), it is estimated that fewer than 20% of women have been screened for cervical cancer, compared with 60% in high-income countries. National screening programs, where available, are saving lives every day and are cost-effective. Scaling-up screening coverage is critical to accelerating progress towards a world without cervical cancer.

The WHO cervical cancer elimination strategy recommends a national target: 70% of women being screened using a high-performance HPV test, by 35 and 45 years of age.

What should my country consider?

Cervical screening and preventive therapy are our second line of defense against cervical cancer. Screening all women at least twice between the ages of 30 and 49 can allow for early detection of precancerous lesions, which in turn can allow women to seek early treatment to prevent their condition from turning into invasive cervical cancer. Through screen-and treat approaches of precancerous lesions, most invasive cervical cancers can  be prevented. Learn more about the different types of screening and treatment methods for precancerous lesions.
Types of Screening Tests
By: USAID

There are several types of cervical screening, which can be used alone or in combination to identify women who are more likely to have either cervical cancer itself or a precancer.

The main types of screening methods available today include HPV DNA testing, visual inspection with acetic acid (VIA), and conventional cytology (pap smear).

Learn More
Types of Treatment for Precancers
By: USAID

Screening must be linked to treatment of precancerous lesions, as screening alone has  no preventive value. Preferably both screening and treatment will take place on-site within the same day to prevent losing patients to follow-up).

The most common types of treatment for precancerous lesions include cryotherapy, thermal ablation, and LEEP (loop electrosurgical excision procedure).

Learn More
Health Service Integration
By: Pixabay

Strengthening integrations across health systems is essential to the delivery of comprehensive sexual and reproductive health (SRH) services for women – including cervical cancer screening and treatment.

By providing cervical cancer screening and treatment as part of HIV prevention and treatment, family planning and STI programming, countries can address the multiple reproductive health needs of women and girls while making a cost-effective use of resources.

Learn More
Types of Screening Tests
Types of Treatment for Precancers
Health Service Integration
By: USAID
By: USAID
By: Pixabay

There are several types of cervical screening, which can be used alone or in combination to identify women who are more likely to have either cervical cancer itself or a precancer.

The main types of screening methods available today include HPV DNA testing, visual inspection with acetic acid (VIA), and conventional cytology (pap smear).

Learn More

Screening must be linked to treatment of precancerous lesions, as screening alone has  no preventive value. Preferably both screening and treatment will take place on-site within the same day to prevent losing patients to follow-up).

The most common types of treatment for precancerous lesions include cryotherapy, thermal ablation, and LEEP (loop electrosurgical excision procedure).

Learn More

Strengthening integrations across health systems is essential to the delivery of comprehensive sexual and reproductive health (SRH) services for women – including cervical cancer screening and treatment.

By providing cervical cancer screening and treatment as part of HIV prevention and treatment, family planning and STI programming, countries can address the multiple reproductive health needs of women and girls while making a cost-effective use of resources.

Learn More

Advocacy and Communication in Action

Overcoming barriers in Malaysia

Did you know that Malaysian women are hesitant to be screened for cervical cancer? This is why Project ROSE provides a self-swab technique that allows women to screen themselves, even from the comfort of their own home. ROSE aims to screen women in both urban and rural parts of Malaysia and addresses the particular barriers to cervical cancer screening in the Malaysian context.

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Leveraging community leaders in Peru

Did you know that cervical cancer is the leading cancer among women in Peru, killing a woman every 5 hours? A demonstration project in Ventanilla, Peru includes the participation of female community leaders, known as “Hope Ladies”.  The “Hope Ladies” spread information about HPV from door to door in their communities and then provide detection equipment to perform convenient and relatively comfortable tests.  By leveraging women within communities to become leaders, over 2,090 women have been successfully screened.

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2 disease, 1 response: HIV and cervical cancer

The link between HIV and cervical cancer is clear ─ women living with HIV are 5-6 times more likely to develop cervical cancer. We now need to bring together the service responses, political will and advocacy communities in order to see progress.

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Follow-up testing in Honduras

Fanny Romero, from Honduras, shares her experience after receiving a screening test result positive for HPV. Fanny recalls that she had put-off screening because she had relocated. Thankfully, the insistence of the healthcare personnel to reach Fanny convinced her to take an HPV DNA test and allowed her to get treatment for precancerous lesions before they became cancer.  Screen-and-treat approaches reduce loss of patients to follow-up, and can reduce the time lag for women to receive treatment.

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