“See and Treat” an Advocated Approach for Precancerous Lesions of the Cervix- A North Indian Referral Center Based Randomized Control Trial

Abstract

Objective: To establish the comparability of two step approach of See and treat with the conventional three step approach In management of Precancerous lesions of the cervix. Methods: A Randomised controlled Trial was conducted in AIIMS Rishikesh over a period of one year (2020-2021). All women presenting to OPD in age group 25-60 years were screened with PAP smear and per speculum examination, and women with Abnormal PAP smear or clinically unhealthy cervix were subjected to colposcopy. Reid and Swede scores were calculated and colposcopy guided biopsy taken. Women with CIN2/3 on either of the colposcopy scores were randomized to two or three step approach. Women falling into two step approach (group A) underwent LEEP in the same sitting while the latter group (group B) was told to follow up with histopathology reports for further management.The final histopathological diagnosis and LEEP results were compared. Results: Overtreatment rates were 22% in see and treat approach, distributed as 3.6% in HSIL + ASC_H group and 33 % in LSIL patients. None were lost to treatment in this group. 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 despite the risk of overtreatment, a two step approach should be considered for preventive management, especially considering the rate of loss to follow up in three step approach. This study thus advocates the use of See and Treat protocol, especially in the high-grade cytology lesions. IN low risk cases too, the study proposes that see and treat protocol can be used, albeit with good clinical judgement. Offering opportunities to reduce suffering associated with the eminently preventable cervical cancer is an ethical imperative and the SEE and TREAT approach is an attempt in that early preventive direction.