World Health Organization Guidelines: Use of cryotherapy for cervical intraepithelial neoplasia

Nancy Santesso, Holger Schünemann, Paul Blumenthal, Hugo De Vuyst, Julia Gage, Francisco Garcia, Jose Jeronimo, Ricky Lu, Silvana Luciani, Swee C. Quek, Tahany Awad, Nathalie Broutet

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Background: In 2008, cervical cancer was responsible for 275 000 deaths, of which approximately 88% occurred in low- and middle-income countries. In 2009, the World Health Organization (WHO) committed to updating recommendations for use of cryotherapy for cervical intraepithelial neoplasia (CIN). Methods and results: We followed the WHO Handbook for Guidelines Development to develop present guidelines. An expert panel was established, which included clinicians, researchers, program directors, and methodologists. An independent group conducted systematic reviews and produced evidence summaries following the GRADE approach. GRADE evidence profiles were created for 16 key questions about the effects of cryotherapy in the presence of histologically confirmed CIN compared with no treatment and with loop electrosurgical excision procedure, as well as the use of different cryotherapy techniques. We identified a small number of randomized controlled trials or independently controlled observational studies. Surrogate outcomes were reported when evidence about outcomes critical to decision making were not available. The panel made 14 recommendations and documented factors that determined the strength and direction of the recommendations in decision tables. Conclusion: The present document summarizes new evidence-based WHO recommendations about the use of cryotherapy in women with histologically confirmed CIN for low-, middle-, and high-income countries.

Original languageEnglish (US)
Pages (from-to)97-102
Number of pages6
JournalInternational Journal of Gynecology and Obstetrics
Issue number2
StatePublished - Aug 2012
Externally publishedYes


  • Cervical cancer
  • Cervical intraepithelial neoplasia
  • Cryotherapy
  • Guidelines
  • Loop electrosurgical excision procedure
  • Recommendations

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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