Overview of thermal ablation devices for treating precancerous cervical lesions in low-resource settings

In 2020, there were an estimated 604 000 cases and 341 000 deaths from cervical cancer [1], with 91% of these deaths occurring in low and middle-income countries (LMICs) [2]. While screening programs have led to a dramatic reduction in cervical cancer rates in high-income countries, their implementation in LMICs has faced many challenges [3]. Screen-and-treat programs, where screening is achieved with human papillomavirus (HPV) testing and/or visual inspection with acetic acid (VIA), have limited impact when feasible treatment options for precancerous cervical lesions are not available. Cryotherapy has historically been recommended as an ablative treatment, but implementation challenges related to obtaining and transporting the necessary refrigerant gas have limited its use in many low-resource settings [4,5]. Similar to cryotherapy, thermal ablation does not require anaesthesia and can be provided by a variety of health care providers [4]. Thermal ablation devices are simple to use, lightweight, portable, and easier to implement than cryotherapy in many settings, while the necessary treatment time for thermal ablation is much shorter than for cryotherapy [4,6]. When thermal ablation is used to treat precancerous cervical lesions at 100-120°C for 20-45 seconds, the depth of necrosis is sufficient, with cure rates comparable to those achieved with cryotherapy [6].