Ontario Cervical Cancer Screening Clinical Practice Guidelines
Table 2. Literature research results
What is the optimal cervical screening tool? Sensitivity and specificity
conventional cytology versus LBC
conventional cytology versus HPV DNA
Rates of unsatisfactory specimens Safety/adverse effects of the intervention Comparison of LBC methodologies
Practice guideline recommendations
2. Do organized cervical screening programs with recall mechanisms reduce the incidence of and mortality due to cervical cancer compared to spontaneous cervical screening?
6 technology assessments11–16 2 technology assessments11,16 3 technology assessments11–13 2 technology assessments12,14 1 technology assessment11 1 systematic review18 2 retrospective studies35,36 3 practice guidelines3,4,6 1 in-press guideline11 6 cross-sectional studies22–27 1 case-control study31
3. What is the most appropriate time for initiation and cessation of cervical screening?
4. At what time interval should women be screened?
5. Should women in special circumstances be screened?
6. What is the optimal management for women with abnormal cytology?
5 published guidelines3–6,8 1 in press guideline11 1 cross-sectional study28 5 published guidelines3–6,8 1 in press guideline11 1 retrospective cohort study37 2 case-control studies32,33 4 published guidelines3–6 1 in press guideline11 1 cross-sectional study29 1 prospective cohort study30 1 case-control study 2 published guidelines7,9 3 RCTs19–21 1 meta-analysis17 4 retrospective studies38–41 1 conference report42 39
HPV: human papilloma virus; LBC: liquid based cytology; RCT: randomized controlled trial.
insufficient or conflicting evidence on which to base the recommendations. In these situations, expert consensus opinion was used to guide the decision-making process.
Internal Review Process
All documents produced in collaboration with the Program in Evidence-Based Care undergo a rigorous internal review process. The cervical screening report drafted by the expert working group and approved by the Cervical Screening Guidelines Development Committee was data-audited, and copy edited by program staff working independently of the Screening Committee. In addition, the draft document was critiqued by the Program’s Guidelines Coordinator and Director before external review.
External Review Process
Following internal review, the draft systematic review and recommendations for practice were circulated to external clinicians for review and feedback. Practitioner feedback was obtained through a survey mailed, on September 15, 2004, to 180 physicians across Ontario (129 family practi- tioners and pathologists, 30 medical oncologists, 1 radiation oncologist, 11 surgeons, and 9 gynaecologists). Reminder postcards were sent to the non-responders two weeks later, and a second reminder (full package) was sent out four weeks later. A third mailing (full package) was sent eight weeks after the initial mailing.
Of the 180 questionnaires sent to family practitioners and pathologists, 55 (31%) were returned. Of these 55
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