Authors' objectives:

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.

Authors' results and conclusions: The evidence about age and hysterectomy is observational, predominantly from population- or care-based data. The findings are consistent: risk of cervical cancer or abnormalities falls with age; high-grade and more severe lesions are detected in fewer than 1 per 1,000 Pap tests among women older than 60 who have had prior screening; and longer histories of prior normal Pap tests further reduces risk. After hysterectomy, high-grade vaginal lesions are rare, fewer than 2 to 4 per 10,000 tests. The literature about new diagnostic tools is limited by lack of histologically validated performance. Using tools such as liquid cytology, neural-net rescreening, and computer-based review algorithms improves sensitivity; however, this improvement is predominantly for detection of low-grade lesions. The impact on specificity is poorly documented. Sensitivity of HPV testing for screening detection of high-grade lesions is competitive with conventional cytology (roughly 82%); specificity is lower (78%); and negative predictive value is good (99%). For triage of women with abnormal Pap tests, sensitivity for detecting high-grade lesions is 85%, specificity is 60%, and negative predictive value is 97%.

Authors' recommendations: The yield of screening among older women who have been previously screened decreases with age; if recommendations are not modified, older women are disproportionately likely to have evaluations for false-positive findings. The prior recommendation of the US Preventive Services Task Force to discontinue Pap testing after hysterectomy for benign disease is supported. For making decisions about screening modality in US populations, evidence about these new technologies for cytology screening and HPV testing is currently limited. Controlled trials and prospective cost evaluation of new screening strategies in each of these areas are required. Important trials will be completed in 2001 that may clarify our conclusions.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/uspstf/uspscerv.htm

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)