Page 36 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter II. Methods

We reviewed 21 articles, the vast majority of which were articles that examined the cost

of operating national screening systems within single payer health systems across Europe. As

our goal was not cost evaluation or modeling, or critique of that literature, we wished to retain

only the most relevant publications for this SER. To be considered, we required that the article

reflect the cost or charges of using the screening modality in a primary care setting in the United

States and that it compare new methods with conventional methods. We included four

publications relevant to cost, including an evidence report from the Agency for Healthcare

Research and Quality (AHRQ), as background references.

In consultation with our team members, USPSTF liaisons, and USPSTF members in

telephone conference, we elected not to examine relative rates of assignment of the diagnosis of

atypical squamous cells of uncertain significance (ASCUS) and cervical intraepithelial neoplasia

I (CIN1) as a potential indicator of “harm.” Many such low-grade lesions regress and watchful

waiting may be as effective as intervention; however, evidence at this time is insufficient to

assert that detection of low-grade changes confers no benefit and only poses potential harm.

Nonetheless, we have emphasized that optimal screening systems maximize identification of

high-grade changes. Similarly, we have noted the potential harm of undergoing unnecessary

evaluation and/or procedures, whether for diagnosis (such as colposcopy) or treatment (such as

loop electrosurgical excision procedure or LEEP), but we have not further examined the harms

of these procedures themselves.

33