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Screening for cervical cancer--an evidence-based approach
A Fraser1, S Hellmann, L Leibovici
1Department of Medicine E, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel.
European Journal of Gynaecological Oncology
|August 27, 2005
Summary
Cervical cancer screening using Pap smears shows weak evidence of effectiveness. Despite this, Israel
Area of Science:
- Gynecologic Oncology
- Public Health Policy
- Cancer Screening
Background:
- The Papanicolau (Pap) smear is a widely accepted tool for detecting cervical cancer and its precursors.
- Israel has an opportunistic cervical cancer screening approach, yet maintains low incidence rates of invasive cervical cancer.
Purpose of the Study:
- To evaluate the evidence for Pap smear screening effectiveness in cervical cancer detection.
- To apply findings to Israeli data and assess implications for current screening policies.
Main Methods:
- A systematic search of Medline and the Cochrane Library was conducted.
- The search included systematic reviews, controlled trials, and cohort studies published from 1966 to June 2003.
Main Results:
- No direct evidence from trials demonstrates that cervical cancer screening improves outcomes.
- A retrospective cohort study indicated a reduced risk of invasive cervical cancer (RR 0.4) for women with at least one Pap smear.
- Preventing one case of cervical cancer in Israel requires screening approximately 27,800 women, at an estimated cost of 1.288 million NIS.
Conclusions:
- Evidence supporting the effectiveness of Pap smear screening for cervical cancer is limited.
- Based on weak evidence and cost-effectiveness estimations, the current opportunistic screening policy in Israel should be maintained.