Page 25 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter I. Introduction

We have denoted the combination of screening components in Figure 2 the “screening

strategy.” Key Questions 2 and 3 (see below) focus on the role of specific components within a

cervical cancer screening strategy.

In this analytic framework, women with normal findings at completion of a screening

strategy return to the routine screening group. Women with abnormal screening tests progress to

further evaluation. Evaluation may fail to identify any abnormalities (false-positive screening

test results) or result in the diagnosis of cervical dysplasia or cancer. Among those who are

diagnosed with an abnormality, the severity of dysplasia or stage of cancer is the primary

determinant of treatment options and morbidity and mortality risk. The success of a screening

strategy depends on early detection of pathology, which then facilitates early treatment,

ultimately resulting in improved length of life, quality of life, or both for women who are

screened.

Key Questions

Our key questions are provided below. They appear in Figure 2 as Key Q1, Key Q2, and

Key Q3 above the related arrows, which indicate steps in the prevention process and disease

progression.

Key Question 1: Who should be screened for cervical cancer and how often?

In developing the work plan for this SER, we specified this question broadly to prompt

discussion of what focus would most contribute to guiding screening in primary care practice.

We considered a range of potential topics including age at initiation of screening, need for

screening among lesbian women, screening recommendations for women with HIV infection,

interval of screening in the general population, screening after hysterectomy, and screening

among older women including the relationship between aging and interval. Practical limitations

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