Cervical cancer: Can it be prevented?

Table 4 Management of preinvasive cancer (American Society for Colposcopy and Cervical Pathology 2012 guidelines)

Lesion on biopsy	Other features	Management
CIN 1	Preceding cytology of ASC-US, ASC-H, LSIL	Follow up with cytology (6, 12 mo) and HPV testing (12 mo)
CIN 1	Preceding cytology of HSIL, AGC-NOS	Either of these: Diagnostic excisional procedure or review of findings or observation with HPV and cytology (12 and 24 mo) (only if colposcopy satisfactory and ECC negative)
CIN 1	Adolescent (< 20 yr)	Follow up with cytology (12 mo)
CIN 1	21-24 yr	Follow up with cytology and colposcopy (6 monthly, up to 2 yr)
CIN 2/3	Satisfactory colposcopy	Either excision or ablation of transformation zone
CIN 2/3	Unsatisfactory colposcopy or recurrence or endocervical disease	Diagnostic excisional procedure
CIN 2/3	Adolescent (< 20 yr) and young women (21-24 yr)	Observation with cytology and colposcopy (only if colposcopy satisfactory) or treatment using excision or ablation of transformation zone
Adenocarcinoma in situ	Specimen from diagnostic excisional procedure	Hysterectomy preferred (rarely conservative management if margins negative and future fertility desired)

HPV: Human papilloma virus. CIN: Cervical intraepithelial neoplasia, ASC-US: Atypical squamous cells - undetermined significance; ASC-H: Atypical squamous cells - cannot exclude; LSIL: Low-grade squamous intraepithelial lesion HSIL: High-grade squamous intraepithelial lesion; ECC: Endocervical curettage.