PATH's Cervical Cancer Prevention Action Planner

Lessons specific to treating cervical lesions with cryotherapy

There are a number of cervical precancer treatment options appropriate for lower-resource settings. PATH recently conducted a search for and evaluation of treatment technologies and scored them for how they met a set of criteria important in low-resource areas. The treatments include excision methods such as the loop electrical excision procedure (LEEP) and laser conization; ablation methods such as cryotherapy and cold coagulation; and pharmaceutical methods such as inhibitors of cell proliferation and anti-viral agents. The criteria selected as important for use in low-resource areas were verified by experts in the field, and included high efficacy and safety, usability for low-level providers, appropriateness for remote settings, and low cost. The assessment is titled Treatment Technologies for Precancerous Cervical Lesions in Low-Resource Settings.

A set of sample standard operating procedures for cervical cancer screening, diagnosis, treatment, infection prevention, and counseling used in India includes information on cryotherapy.

Client- and provider-perceived benefits of cryotherapy

  • Cryotherapy is a highly effective intervention in many situations, with good cure rates.
  • Nurses and other staff can be trained to perform cryotherapy safely.
  • Cryotherapy does not require mains electricity (though the provider must have a lamp or flashlight to be able to visualize the cervix).
  • The initial equipment costs for cryotherapy may be high, but the equipment is long-lasting and the only consumable supply is gas.

Client- and provider-perceived drawbacks of cryotherapy

  • In some places CO2 or N2O gas may be difficult or expensive to procure on a routine basis.
  • Cryotherapy equipment may be difficult to set up or repair locally.
  • The quality of gas varies and lower-quality gas can cause problems with the equipment.
  • Sometimes it can be difficult to maintain effective freezing temperatures at the cryotherapy probe tip.
  • Women experience a watery discharge for about four weeks after treatment while they are healing following treatment. During that time, they need to avoid sexual intercourse, or use a condom to avoid infection.

Strategies appropriate for treatment using cryotherapy

  • Due to cost of equipment and difficulty of maintaining gas supplies in widespread locations, it may not be feasible or cost-effective to implement cryotherapy services everywhere that screening could be offered. Therefore, some programs now are creating hubs of cryotherapy services that treat women referred by associated health posts and clinics which offer VIA or HPV DNA screening.
  • Higher level facilities, in hospitals, for instance, can offer more complex, physician-dependent treatment such as LEEP.
  • Programs also may choose to organize periodic outreach of mobile cryotherapy services when sufficient cases have accumulated at a facility or in a community.
Photo: PATH/Darin Zehrung

Additional resources

Print version: Cervical cancer screening and treatment in low-resource settings (PDF, RHO Cervical Cancer website)

Watch videoScreening and Treatment of Precancerous Lesions video and transcript

Screening and treatment (RHO Cervical Cancer website)

World Health Organization: Comprehensive Cervical Cancer Control: A guide to essential practice (PDF)

Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers (PDF)

Evidence-Based, Alternative Cervical Cancer Screening Approaches in Low-Resource Settings

Strategic Plan for Cervical Cancer Prevention and Control in Uganda (PDF)

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