Page 75 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter IV. Discussion

Future Research Needs

Future research must address outcomes of specific screening strategies, not only

descriptive statistics and evaluation of test characteristics. On-going projects in the area of HPV

testing may be the only areas of experimental research testing explicit hypotheses about the best

approach to Pap testing. Until large randomized trials or well-designed prospective studies

(capable of measuring and adjusting for anticipated biases) are done, especially ones that address

topics such as age to discontinue screening and actual costs of new technologies, the relative

benefits of one screening strategy over another are unproven and difficult to promote. The

notable exception to indecision in the face of insufficient evidence is consumer demand for use

of new technologies, at intervals unlikely to be cost-effective.

The community of cervical cancer researchers oriented towards preventive interventions

and screening have consistently called for research of these types:

• Study of the factors that determine uptake and continuance of screening, provider and

patient preferences, and adherence to appropriate screening, follow-up, and

evaluation;

• Investigation of the potential for automated screening processes, such as

computerized re-screening and screening, to reduce between laboratory variations in

quality;

• Comparison of cytology technologies and HPV testing methods with a histologic

reference standard including verification of the status of individuals, or a sample of

individuals, with normal test results;

• Direct, prospective comparisons of screening strategies that include assessment of

health outcomes and cost;

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