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Table 1. Details of inclusion criteria


1. What is the optimal cervical screening tool?

Inclusion Criteria

  • compare conventional cytology to liquid-based cytology or to HPV DNA testing. compare various LBC methodologies


Sensitivity, specificity of the intervention Rates of unsatisfactory specimens Safety/adverse effects of the intervention

  • 2.

    Do organized cervical screening programs with recall mechanisms reduce the incidence of and mortality due to cervical cancer?

  • 3.

    What is the most appropriate time for initiation and cessation of cervical screening?

compare organized cervical screening programs to spontaneous cervical screening.

describe the optimum time for initiation of cervical screening.

Rates of detection of abnormal cytology Mortality due to cervical cancer

Rates of detection of abnormal cytology

describe the optimum time cervical screening cessation. Results of cervical abnormalities were to be reported separately for women who had a negative screening history.

  • 4.

    At what time interval should women be screened?

  • 5.

    Should women in special circumstances be screened?

describe optimum time intervals for cervical screening.

describe optimal cervical screening procedures for women in one of the following special circumstances: pregnant women, women post-hysterectomy, HIV positive women.

Rates of detection of abnormal cytology

Rates of detection of abnormal cytology

Appropriateness of screening tool—reports sensitivity and specificity

6. What is the optimal management for women with abnormal cytology?

describe optimum management for women with abnormal cytology.

Rates of detection of cervical cancer

describe optimum management for women at least up to but not necessarily including colposcopy/HPV management

HPV: Human papilloma virus; LBC: liquid based cytology; RCT: randomized controlled trial.

randomized controlled trials were of primary interest; how- ever, given the variability of the data, other study designs or information sources were considered eligible if there was a demonstrated gap in information in the identified



Literature Search Results Seven practice guidelines,3–9

one practice guideline in

press,10 six technology assessments,11–16 one meta- analysis,17 one systematic review,18 three randomized controlled trials,19–21 eight cross-sectional studies,22–29 one prospective cohort study,30 four case-control studies, seven retrospective studies,35–41 and one conference report42 provide the evidence for this practice guideline. The literature results according to six questions of interest are shown in Table 2. 31–34

Data Extraction

Data identified in the literature were extracted by a methodologist, and results were organized under the six areas of interest and reviewed by expert subcommittees.

The expert working group applied the Appraisal of Guide- lines Research and Evaluation instrument (AGREE), a

rating system for guidelines,43 to the seven published guide- lines identified in the search of the literature (Table 3). The guidelines included publications from the United States, Canada, Great Britain, and New Zealand. The average score was calculated for each question. The seven guidelines scored consistently well on several AGREE criteria, includ- ing guideline development by a variety of professional stakeholders and making specific and unambiguous recom- mendations. There were some differences in the develop- ment and presentation of the guidelines. Five guide- lines3–5,7,.9 clearly outlined the systematic methodology for collecting data, and two guidelines6.8 did not.

Synthesis of the Evidence and the Development of Recommendations

Results of the systematic review of the literature and the methodology of the Program in Evidence-Based Care are available in full elsewhere.44 On the basis of the systematic review of the evidence, a quality assessment of identified guidelines, and expert interpretation of the evidence, the Cervical Screening Guidelines Development Committee synthesized the evidence according to six questions of inter- est and developed recommendations on cervical screening. During this review, opportunities for feedback on the draft guidelines included both face-to-face meetings and elec- tronic correspondence. In some areas, there was



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