Page 22 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter I. Introduction

importance of assessing potential harms of screening becomes clear. The psychological effects

of labeling young women with an anxiety-provoking, possibly precancerous condition, and the

associated individual, health care system, and societal costs deserve attention. Ideally, screening

tools would help guide selection of the intensity of intervention across the spectrum of cervical

dysplasia.

For this report, we sought evidence about screening in older age groups and after

hysterectomy. We also looked at methods to determine the optimal interval and at the potential

contribution of new technologies and HPV testing methods to clinical prevention of cervical

cancer. Furthermore, we sought evidence about the cost implications, the population to be

screened, and potential harms that follow from screening.

Prior Recommendations

US Preventive Services Task Force

The second edition of the Guide to Clinical Preventive Services from the US Preventive

Services Task Force gave an “A” to the recommendation of a regular Pap test for all women who

4
are or have been sexually active and who have a cervix.
4
The Task Force further stipulated (pg 112):

There is little evidence that annual screening achieves better outcomes than screening
every 3 years (“B” recommendation). The interval for each patient should be
recommended by the physician based on risk factors. There is insufficient evidence to
recommend for or against an upper age limit for Pap testing, but recommendations can be
made on other grounds to discontinue regular testing after age 65 in women who have
had regular previous screening in which the testing has been consistently normal (“C”
recommendation). Women who have undergone a hysterectomy in which the cervix was
removed do not require Pap testing unless the hysterectomy was performed because of
cervical cancer or its precursors.

12