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153 ”See and treat”: an advocated perspective for pre invasive lesions of the cervix
  1. A Gaurav,
  2. D Kapur,
  3. K Khoiwal,
  4. S Choudhuri,
  5. AK Ravi and
  6. J Chaturvedi
  1. All India institute of medical sciences, Rishikesh, Obstetrics and Gynaecology, RISHIKESH, India


Introduction/Background*Secondary prevention of cervical cancer should remain a key priority for women’s health globally for decades to come, especially in developing countries. A See-and-treat procedure is a step towards the same. The present study was conducted to establish the two-step approach of See and treat in preference to the conventional three-step protocol In the management of Cervical intraepithelial neoplasm

Methodology A Randomized controlled trial was conducted in AIIMS Rishikesh, Uttarakhand, India, from July 2018- July 2020. All women presenting to the outpatient clinic in the age group 25-60 were screened with per speculum examination and PAP smear. Colposcopy was performed on women with Abnormal PAP smear or clinically unhealthy cervix. Colposcopic guided biopsy was done when indicated. Women with CIN2/3 were randomized to a two or three-step approach. Women falling into the two-step approach(group a) underwent LEEP/Thermal Ablation/Cold knife conization in the same setting. In contrast, Group B was advised to follow up with histopathology reports for further management. The authors studied the final histopathological diagnosis to determine the adequacy of treatment.

Result(s)*Overtreatment rates were 22% in See and treated approach, distributed as 3.6% in HSIL + ASC_H group and 33% in LSIL patients. 39 out of 50 women in Group B needed definitive treatment after their biopsy results, and 48% of them were lost to follow up. 72% were adequately treated in group A while only 22% could be adequately treated in Group B.

Conclusion*It can thus be safely concluded that a two-step approach should be considered for preventive management, especially considering the rate of loss to follow up in a three-step approach despite the risk of overtreatment. This study thus advocates the use of the See and Treat protocol, especially in high-grade cytology lesions. In low-risk cases, too, the study proposes that see and treat protocol can be used, albeit with good clinical judgment. Offering opportunities to reduce the suffering associated with the eminently preventable cervical cancer is an ethical imperative. The SEE and TREAT approach is an attempt in that early preventive direction.

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