Page 117 - Screening for Cervical Cancer: Systematic Evidence Review

Appendix C. Evidence Tables

Evidence Table 1B. Pap Testing After Hysterectomy

Screening Outcomes & Quality
Participants Program Measures Relevant Results Considerations
N=21,152 Pap Not stated Primary outcome Results from cross-sectional Grade=Fair
smears (cross hysterectomy = abnormal Pap, study: Rates of abnormality
sectional study) defined as among women
5330 s/p ASCUS, Among all 8.2/1000
hysterectomy dysplasia (low Among those with hysterectomy
and high grade 1.7/1000
N=173 nested SIL) or carcinoma Among those without
case-control as determined by hysterectomy
study cytopathologist 10.4/1000
(n=173) and
Age >= 50 reported by From case-control study:
years; women hysterectomy Odds ratios for an abnormal
being followed status screening Pap=0.09 (95%
up for previous CI=0.02-0.24) for those with
abnormality or For case-control hysterectomy versus those
with bleeding/ study, primary without
discharge exposure=
excluded hysterectomy
status
Population base
is 97% white

N=9610 smears Not stated Primary 27/79 women with abnormal Grade=Fair
among women outcome= Paps referred for colposcopy,
with abnormal Pap, 5/27 found to have biopsy-
hysterectomy defined as proved VAIN on colposcopy
and without ASCUS, LGSIL, (PPV of Pap for VAIN detection
history of HGSIL, or 6.3%, 95% CI 3.1 to 18.0); no
cervical, vaginal, squamous-cell biopsy proved cases of
ovarian, fallopian carcinoma; carcinoma
tube or uterine classified by two
cancer, or CIN III independent
cytopathologists
Mean age=52 following review

83% black race 27/79 women
with abnormal
results verified
with colposcopy

C-23