Studies with a total of 235,613 participants included
IQWiG searched for studies comparing primary screening strategies for cervical cancer based on different screening tests: a strategy including HPV testing alone or in combination with cytology-based testing and a strategy including cytology-based testing alone.
Six randomized controlled trials conducted in the United Kingdom, Finland, Sweden, the Netherlands, and Italy were included in the assessment. A total of 235,613 women had been recruited for the studies in order to be examined for precursors of invasive cervical cancer in at least two screening rounds with an interval of at least three years. However, all of these studies were susceptible to bias, which limits their informative value.
Fewer cancer diagnoses in the second screening round
In the assessment IQWiG distinguished between different outcome criteria. The composite outcome "CIN3+" was analysed, which comprises both invasive cervical cancer and advanced precursors of cancer (high grade cervical intraepithelial dysplasia or in-situ cervical cancer, i.e. CIN3/CIS). In addition, the outcomes "invasive cervical cancer"- that is, not just the occurrence of a cancer precursor but of a tumour - as well as "CIN3/CIS" were analysed separately.
In the second screening round, the number of diagnoses for the two outcomes "CIN3+" and "invasive cervical cancer" was lower in the HPV group than in the group of women who had only been examined with a cytology-based screening strategy (e.g. Pap smear) in the first screening round. IQWiG therefore determined an indication of a
|Contact: Dr. Anna-Sabine Ernst|
Institute for Quality and Efficiency in Health Care