Screening for Cervical Cancer With High-Risk Human Papillomavirus Testing: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
Joy Melnikow,Jillian T. Henderson,Brittany U Burda,Caitlyn A Senger,Shauna Durbin,Meghan S Weyrich +5 more
TLDR
Both hrHPV screening strategies had higher false-positive and colposcopy rates than cytology, which could lead to more treatments with potential harms, and the IPD meta-analysis found lower risk of invasive cervical cancer with any hr HPV screening compared with cytology alone.Abstract:
Importance Cervical cancer can be prevented with detection and treatment of precancerous cell changes caused primarily by high-risk types of human papillomavirus (hrHPV), the causative agents in more than 90% of cervical cancers. Objective To systematically review benefits and harms of cervical cancer screening for hrHPV to inform the US Preventive Services Task Force. Data Sources MEDLINE, PubMed, PsycINFO, and the Cochrane Collaboration Registry of Controlled Trials from January 2011 through February 15, 2017; surveillance through May 25, 2018. Study Selection Randomized clinical trials (RCTs) and cohort studies comparing primary hrHPV screening alone or hrHPV cotesting (both hrHPV testing and cytology) with cytology (Papanicolaou [Pap] test) screening alone. Data Extraction and Synthesis Two investigators independently reviewed abstracts and full-text articles and quality rated included studies; data were qualitatively synthesized. Main Outcomes and Measures Invasive cervical cancer; cervical intraepithelial neoplasia (CIN); false-positive, colposcopy, and biopsy rates; psychological harms. Results Eight RCTs (n = 410 556), 5 cohort studies (n = 402 615), and 1 individual participant data (IPD) meta-analysis (n = 176 464) were included. Trials were heterogeneous for screening interval, number of rounds, and protocol. For primary hrHPV screening, evidence was consistent across 4 trials demonstrating increased detection of CIN 3 or worse (CIN 3+) in round 1 (relative risk [RR] range, 1.61 [95% CI, 1.09-2.37] to 7.46 [95% CI, 1.02-54.66]). Among 4 hrHPV cotesting trials, first-round CIN 3+ detection was not significantly different between screening groups; RRs for cumulative CIN 3+ detection over 2 screening rounds ranged from 0.91 to 1.13. In first-round screening, false-positive rates for primary hrHPV screening ranged from 6.6% to 7.4%, compared with 2.6% to 6.5% for cytology. For cotesting, false-positives ranged from 5.8% to 19.9% in the first round of screening, compared with 2.6% to 10.9% for cytology. First-round colposcopy rates were also higher, ranging 1.2% to 7.9% for primary hrHPV testing, compared with 1.1% to 3.1% for cytology alone; colposcopy rates for cotesting ranged from 6.8% to 10.9%, compared with 3.3% to 5.2% for cytology alone. The IPD meta-analysis of data from 4 cotesting trials and 1 primary hrHPV screening trial found lower risk of invasive cervical cancer with any hrHPV screening compared with cytology alone (pooled RR, 0.60 [95% CI, 0.40-0.89]). Conclusions and Relevance Primary hrHPV screening detected higher rates of CIN 3+ at first-round screening compared with cytology. Cotesting trials did not show initial increased CIN 3+ detection. Both hrHPV screening strategies had higher false-positive and colposcopy rates than cytology, which could lead to more treatments with potential harms.read more
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Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement.
US Preventive Services Task Force,Susan J. Curry,Alex H. Krist,Douglas K Owens,Douglas K Owens,Michael J. Barry,Aaron B. Caughey,Karina W. Davidson,Chyke A. Doubeni,John W. Epling,Alex R. Kemper,Martha Y. Kubik,C. Seth Landefeld,Carol M. Mangione,Maureen G. Phipps,Michael Silverstein,Melissa A. Simon,Chien-Wen Tseng,John B. Wong +18 more
TL;DR: The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone in women aged 21 to 29 years substantially outweigh the harms and screening women younger than 21 years does not provide significant benefit.
Journal ArticleDOI
Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society
Elizabeth T. H. Fontham,Andrew M.D. Wolf,Timothy R. Church,Ruth Etzioni,Ruth Etzioni,Christopher R. Flowers,Abbe Herzig,Carmen Guerra,Kevin C. Oeffinger,Ya Chen Tina Shih,Louise C. Walter,Jane J. Kim,Kimberly S. Andrews,Carol DeSantis,Stacey A. Fedewa,Deana Manassaram-Baptiste,Debbie Saslow,Richard C. Wender,Robert A. Smith +18 more
TL;DR: The American Cancer Society recommends that individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, discontinue all cervical cancer screening (qualified recommendation).
Journal ArticleDOI
Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening.
Robert A. Smith,Kimberly S. Andrews,Durado Brooks,Stacey A. Fedewa,Deana Manassaram-Baptiste,Debbie Saslow,Richard C. Wender +6 more
TL;DR: The current American Cancer Society cancer screening guidelines are summarized, and the most current data from the National Health Interview Survey are provided on the utilization of cancer screening for men and women and on the adherence of men andWomen to multiple recommended screening tests.
Journal ArticleDOI
Circulating tumor DNA and liquid biopsy in oncology
TL;DR: The full potential of ctDNA liquid biopsy in the diagnosis, characterization and management of solid and hematological malignancies will be uncovered through interventional clinical trials evaluating clinical utility.
Journal ArticleDOI
Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement
Susan J. Curry,Alex H. Krist,Douglas K Owens,Douglas K Owens,Michael J. Barry,Aaron B. Caughey,Karina W. Davidson,Chyke A. Doubeni,John W. Epling,Alex R. Kemper,Martha Y. Kubik,C. Seth Landefeld,Carol M. Mangione,Maureen G. Phipps,Michael Silverstein,Melissa A. Simon,Chien-Wen Tseng,John B. Wong +17 more
TL;DR: Author(s): Curry, Susan J; Krist, Alex H; Owens, Douglas K; Barry, Michael J; Caughey, Aaron B; Davidson, Karina W; Doubeni, Chyke A; Epling, John W; Kemper, Alex R; Kubik, Martha; Landefeld, C Seth; Mangione, Carol M; Phipps, Maureen G; Silverstein, Michael; Simon, Melissa A; Tseng, Chien
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