Page 24 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter I. Introduction

Analytic Framework and Key Questions

The RTI-University of North Carolina Evidence-based Practice Center (RTI-UNC EPC),

together with members of the USPSTF and other clinical and methodologic experts (see

Appendix A), sought to update specific topics in the area of cervical cancer screening that have

evolved rapidly in the past 5 years. This systematic evidence review (SER) updates Chapter 9

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(pages 105-117) of the second Guide to Clinical Preventive Services.

Analytic Framework

Conceptualizing approaches to cervical cancer screening in primary care practice requires

an analytic framework. Our framework (Figure 2) is not intended to provide etiologic detail;

rather, it depicts the relationship between the progression of disease and the potential points of

intervention to prevent morbidity and mortality. These potential points of intervention provide

the rationale for the questions undertaken in this systematic review.

The pathway starts with women potentially eligible for screening. We have

conceptualized screening as a process that may have more than one component. For example, a

woman presenting for care may have her individual risk for cervical cancer assessed based on

her past sexual history, medical history, and prior Pap test results. Using that information,

clinicians determine the need for a Pap test. If a Pap test is done, the specimen may be prepared

by conventional methods or new techniques. The cytology specimen may be read in the

conventional manner or with pre-screening or re-screening by computer-assisted methods. Other

screening studies, such as HPV testing, may be incorporated before a woman is determined to

have normal or abnormal screening results.

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