Recommendations on screening for cervical cancer

,

doi:10.1503/cmaj.121505

Cited by 157 publications

(63 citation statements)

References 72 publications

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“…Many European Union countries do not initiate screening until the age of 25 or 30 (19, 20). Likewise, Canadian guidelines now recommend against cervical cancer screening in those under 25 years of age (21). The population risks in these western countries are comparable to the U.S., indirectly affirming that there is little cancer prevention benefit in screening these young women, even without vaccination.…”

Section: Discussionmentioning

confidence: 99%

Age-Specific Occurrence of HPV16- and HPV18-Related Cervical Cancer

Sanjosé

Wheeler²,

Quint

et al. 2013

Cancer Epidemiology, Biomarkers &Amp; Prevention

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The age-specific of occurrence of cervical cancer related to human papillomavirus genotypes HPV16 and HPV18, the two targeted by current HPV vaccines, is not well described. We therefore used data from two large, tissue-based HPV genotyping studies of cervical cancer, one conducted in New Mexico (USA) (n = 744) and an international study restricted to cancers (n = 1,729) from Europe, North America, and Australia to represent those regions with widely available cervical cancer screening facilities. HPV results were categorized as HPV16 or HPV18 positive (HPV16/18) versus other HPV genotype. We observed a decreasing proportion of HPV16/18-positive cancers with increasing age in the international study (ptrend < 0.001) and New Mexico study (ptrend < 0.001). There was no heterogeneity in the relationship between age of diagnosis and the proportion of HPV16/18-positive cancers between studies (p = 0.8). Combining results from the two studies (n = 2,473), the percentages of HPV16/18-positive cases were 77.0% (95%CI: 75.1%-78.9%) for women less than 65 years old and 62.7% (95%CI: 58.4%-66.9%) for women aged 65 and older (p < 0.001). In women who are under the age of 25 and have been vaccinated before becoming sexually active, the cervical cancer incidence is expected to be approximately 3.5 per million by 2020. HPV vaccination against HPV16/18 may have a greater impact on cervical cancers in women under 65 than in women aged 65 and older. These data will inform the age-specific impact of HPV vaccination and its integration with cervical cancer screening activities.

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Section: Discussionmentioning

confidence: 99%

Age-Specific Occurrence of HPV16- and HPV18-Related Cervical Cancer

Sanjosé

Wheeler²,

Quint

et al. 2013

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Screening tests such as conventional cytology (commonly referred to as the Pap smear) are used to identify pre-cancers, which can be treated to prevent the occurrence of invasive cancer or allow the disease to be identified at an earlier stage, permitting more effective treatment. The systematic review on which this paper is based provided evidence for the Canadian Task Force on Preventive Health Care to update their guideline regarding screening of average-risk women for cervical cancer [2,3]. …”

Section: Introductionmentioning

confidence: 99%

Screening for cervical cancer: a systematic review and meta-analysis

Peirson¹,

Fitzpatrick‐Lewis²,

Ciliska³

et al. 2013

Syst Rev

339

237

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BackgroundThe systematic review on which this paper is based provided evidence for the Canadian Task Force on Preventive Health Care to update their guideline regarding screening for cervical cancer. In this article we highlight three questions covered in the full review that pertain to the effectiveness of screening for reducing cervical cancer mortality and incidence as well as optimal timing and frequency of screening.MethodsWe searched MEDLINE, Embase and Cochrane Central from 1995 to 2012 for relevant randomized controlled trials and observational studies with comparison groups. Eligible studies included women aged 15 to 70 years who were screened using conventional cytology, liquid-based cytology or human papillomavirus DNA tests. Relevance screening, data extraction, risk of bias analyses and quality assessments were performed in duplicate. We conducted a meta-analysis using a random-effects model on the one body of evidence that could be pooled.ResultsFrom the 15,145 screened citations, 27 papers (24 studies) were included; five older studies located in a United States Preventive Services Task Force review were also included. A randomized controlled trial in India showed even a single lifetime screening test significantly decreased the risk of mortality from and incidence of advanced cervical cancer compared to no screening (mortality: risk ratio 0.65, 95% confidence interval 0.47, 0.90; incidence: relative risk 0.56, 95% confidence interval 0.42, 0.75). Cytology screening was shown to be beneficial in a cohort study that found testing significantly reduced the risk of being diagnosed with invasive cervical cancer compared to no screening (risk ratio 0.38; 95% confidence interval 0.23, 0.63). Pooled evidence from a dozen case–control studies also indicated a significant protective effect of cytology screening (odds ratio 0.35; 95% confidence interval 0.30, 0.41). This review found no conclusive evidence for establishing optimal ages to start and stop cervical screening, or to determine how often to screen; however the available data suggests substantial protective effects for screening women 30 years and older and for intervals of up to five years.ConclusionsThe available evidence supports the conclusion that cervical screening does offer protective benefits and is associated with a reduction in the incidence of invasive cervical cancer and cervical cancer mortality.

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“…Moreover, the age distribution of cervical cancer is changing and studies regarding appropriate commencing age of screening are being reported. Consequently new screening guidelines including adjusted timing of cervical cancer screening are being published in multiple nations and organizations [ 2 3 4 5 6 7 8 9 10 ]. To cope with such changes, a novel cervical cancer screening guideline that meets the situation in Korea is needed.…”

Section: Introductionmentioning

confidence: 99%

The Korean guideline for cervical cancer screening

et al. 2015

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The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass-screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (Papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The cervical cytology combined with HPV test is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within 10 years (recommendation D).

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Recommendations on screening for cervical cancer

Cited by 157 publications

References 72 publications

Age-Specific Occurrence of HPV16- and HPV18-Related Cervical Cancer

Age-Specific Occurrence of HPV16- and HPV18-Related Cervical Cancer

Screening for cervical cancer: a systematic review and meta-analysis

The Korean guideline for cervical cancer screening

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