Page 8 - Screening for Cervical Cancer: Systematic Evidence Review

Structured Abstract

Structured Abstract

Context: Methods that improve detection of serious cervical lesions while minimizing

excess screening are the key to advancing cervical cancer prevention.

Objective: To examine the evidence about benefits and harms of screening among older

women (ages 65 and older) and those who have had hysterectomies, and to examine the

diagnostic performance of new technologies and human papilloma virus (HPV) testing for

detecting cervical lesions.

Data Sources: We identified English-language articles on cervical neoplasia, cervical

dysplasia, and screening from a comprehensive search of the MEDLINE database from 1995

through June 2000. In addition, we used published systematic reviews, the second Guide to

Clinical Preventive Services, and peer review to assure a complete update of specific topics.

Study Selection: We included articles that reported on screening for squamous cell

carcinoma of the cervix if they included the age distribution of the study population and

presented analyses stratified by age or if they included hysterectomy status as a covariate. For

diagnostic tools, we required that the test be used as part of a screening strategy, that the method

be compared with a reference standard, and that all cells of a 2x2 table can be completed.

Data Extraction: We extracted the following data from articles addressing screening

among older women and those who have had a hysterectomy: study design, objectives, location

and timeframe, source of the data (e.g., population-based registry), participants, screening

program used, outcomes and measures, and results relevant to age and screening interval. For

articles about diagnostic tests, we extracted study design, test methods, location, patient

population, outcome measures (emphasizing documentation of the reference standard),

prevalence of lesions, and test characteristics including sensitivity, specificity, and predictive

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