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Cervical Cancer Health Center

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Cervical Cancer Screening (PDQ®): Screening - Health Professional Information [NCI] - Overview

Note: Separate PDQ summaries on Cervical Cancer Prevention, Cervical Cancer Treatment, and Levels of Evidence for Cancer Screening and Prevention Studies are also available.

Screening With the Papanicolaou (Pap) Test: Benefits

Based on solid evidence, regular screening of appropriate women for cervical cancer with the Pap test reduces mortality from cervical cancer. The benefits of screening women younger than 21 years are small because of the low prevalence of lesions that will progress to invasive cancer. Screening is not beneficial in women older than 65 years if they have had a history of recent negative tests.[1,2,3]

Magnitude of Effect: Regular Pap screening decreases cervix cancer incidence and mortality by at least 80%.

Study Design: Population-based and cohort studies.
Internal Validity: Good.
Consistency: Good.
External Validity: Good.

Screening With the Pap Test: Harms

Based on solid evidence, regular screening with the Pap test leads to additional diagnostic procedures (e.g., colposcopy) and treatment for low-grade squamous intraepithelial lesions (LSIL), with long-term consequences for fertility and pregnancy. These harms are greatest for younger women, who have a higher prevalence of LSIL, lesions that often regress without treatment. Harms are also increased in younger women because they have a higher rate of false-positive results.

Magnitude of Effect: Additional diagnostic procedures were performed in 50% of women undergoing regular Pap testing. Approximately 5% were treated for LSIL. The number with impaired fertility and pregnancy complications is unknown.

Study Design: Evidence obtained from cohort or case-control studies.
Internal Validity: Good.
Consistency: Good.
External Validity: Good.

Screening With the Human Papillomavirus (HPV) DNA Test: Benefits

Based on solid evidence, screening with HPV DNA or HPV RNA detects high-grade cervical dysplasia, a precursor lesion for cervical cancer. Additional clinical trials show that HPV testing is superior to other cervical cancer screening strategies. In April 2014, the U.S. Food and Drug Administration approved an HPV DNA test that can be used alone for the primary screening of cervical cancer in women aged 25 years and older.[4]

Magnitude of Effect: In one prospective, clustered, randomized trial, HPV testing was superior to other strategies for preventing cervical cancer mortality.

Study Design: Clustered randomized controlled trial (RCT).
Internal Validity: Good.
Consistency: Good.
External Validity: Good.
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