Page 59 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter III. Results

literature search strategy we used for this SER by confirming that we were identifying

appropriate publications.

Screening Use of HPV Testing

Six studies relevant to primary screening uses of HPV testing met four strict criteria for

inclusion:

1. HPV specimen obtained and evaluated as a screening test;

2. Performance of HPV for predicting presence of CIN was evaluated by colposcopy

and/or histology as the reference standard;

3. HPV test and reference standard were applied within an average of 3 months; and

4. A validation of negative HPV results was undertaken, such that a complete 2x2

table relating the HPV test findings to the reference standard can be completed.

These articles are summarized in detail in Evidence Table 3A. Table 7 extracts key

features of all 6 studies and their populations to demonstrate the varied spectrum of disease in the

populations screened. Although each of these studies used HPV testing in a population or clinic-

based sample that enrolled consecutive women in a fashion comparable to screening use, 5 of the

6 studies used a study population at high risk for cervical dysplasia. One obtained specimens

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from HIV-positive German women; 2 were based in Zimbabwe and enrolled primary care

patients in a population chosen for high prevalence of HIV infection; 62,63 1 selected participants

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in Cape Town, South Africa, with no prior screening; and 1 enrolled women from Guanacaste

Province, Costa Rica, where cervical cancer screening has been relatively unsuccessful in

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reducing cervical cancer incidence. Only Cuzick and colleagues’ study of 2,988 women

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