- An estimated 1300 new cases of cervical cancer were diagnosed in Canada in 2011, with about 350 deaths. The incidence and mortality of cervical cancer have substantially decreased in the past 50 years due to screening.
- Screening for cervical cancer using the Pap test detects precursor lesions, allowing earlier treatment and reducing incidence of invasive disease and death from cervical cancer.
- This guideline provides updated recommendations for cervical cancer screening in Canada based on new evidence about epidemiology and diagnosis of cervical cancer. It recommends screening with Pap tests every 3 years for women aged 30-69, and discusses potential benefits and harms of screening for other age groups.
This document discusses screening for early detection of ovarian cancer. Pelvic examinations are currently the standard screening method, but evidence shows they often find benign conditions and lead to unnecessary follow-up procedures. Blood tests measuring tumor markers and imaging tests also have limitations in screening. While earlier detection could improve outcomes, currently available screening methods are not sufficiently effective at finding early ovarian cancers. Improved screening approaches are still needed.
This document discusses screening for ovarian cancer. It notes that ovarian cancer often presents at an advanced stage and has a poor survival rate as a result. Screening aims to detect the cancer earlier when it is more treatable. However, current screening methods like pelvic exams and the tumor marker CA-125 lack sufficient accuracy. A large clinical trial found that annual screening using transvaginal ultrasound and CA-125 did not result in earlier detection or reduced mortality compared to no screening. The high rate of false positives can lead to unnecessary surgeries, which pose risks. More accurate tests are needed for population-wide ovarian cancer screening to be effective.
Primary High Risk HPV Testing with Cyctology TriagePHEScreening
1) Primary testing for high-risk HPV will replace cytology-based screening as the initial test in the NHS cervical screening program. Women who test positive for high-risk HPV will receive cytology triage, while HPV-negative women will be returned to routine recall.
2) A large trial showed primary HPV testing improved sensitivity over cytology alone. A pilot of primary HPV testing confirmed benefits and informed clinical protocols.
3) Women will receive results and follow-up management based on HPV and cytology results, with longer recall for HPV-negative women and colposcopy referral for HPV-positive women with abnormal cytology.
The document discusses breast cancer screening and overdiagnosis. It analyzes data on breast cancer incidence rates in the US from 1976 to 2008. The analysis shows that mammography screening has doubled the number of early-stage breast cancers detected each year, but decreased late-stage cancer cases by only 8%. This suggests that screening may be overdiagnosing breast cancer, detecting some cases that would never have caused harm. While screening increases early detection, it only marginally reduces the rate of women being diagnosed with advanced cancer. The results indicate that breast cancer may be overdiagnosed and screening has only a small effect on reducing mortality from the disease.
Briefing Note: Cervical Cancer Screening in the Gwassi Division, Suba Distric...sarahsteklov
A briefing note on cervical cancer screening practices in the Gwassi Division, Suba District, Nyanza Province, Kenya. Includes WHO guidelines, a pilot study in a neighboring region and interview and survey data from the community.
This document provides updated guidelines for healthcare providers on managing menopause in asymptomatic healthy women and women with menopausal symptoms. It presents lifestyle interventions, medications, and complementary therapies for treating menopausal symptoms according to their efficacy. It also reviews counselling strategies for sexuality concerns during peri- and postmenopause. Approaches to identifying and treating osteoporosis risk are presented in a companion guideline. The guidelines are based on a literature review of recent clinical practice guidelines, randomized controlled trials, observational studies, and other sources.
This document discusses cancer screening. It defines screening as testing asymptomatic individuals at regular intervals to detect cancer early. The goals of screening are to detect cancer early to prevent death and suffering while using minimal treatment. For screening to be effective, the disease must have a detectable preclinical phase and early treatment must improve outcomes. Screening can detect cancer earlier and allow less invasive treatment, but also has risks like overdiagnosis and false positives. Proper evaluation of screening programs is important to understand outcomes and costs. Guidelines recommend screening for breast, cervical and prostate cancers in average risk individuals.
Deborah K. Armstrong, M.D., explains the newly-released patient guide for ovarian cancer patients, which was sponsored by the National Ovarian Cancer Coalition (NOCC).
This document discusses screening for early detection of ovarian cancer. Pelvic examinations are currently the standard screening method, but evidence shows they often find benign conditions and lead to unnecessary follow-up procedures. Blood tests measuring tumor markers and imaging tests also have limitations in screening. While earlier detection could improve outcomes, currently available screening methods are not sufficiently effective at finding early ovarian cancers. Improved screening approaches are still needed.
This document discusses screening for ovarian cancer. It notes that ovarian cancer often presents at an advanced stage and has a poor survival rate as a result. Screening aims to detect the cancer earlier when it is more treatable. However, current screening methods like pelvic exams and the tumor marker CA-125 lack sufficient accuracy. A large clinical trial found that annual screening using transvaginal ultrasound and CA-125 did not result in earlier detection or reduced mortality compared to no screening. The high rate of false positives can lead to unnecessary surgeries, which pose risks. More accurate tests are needed for population-wide ovarian cancer screening to be effective.
Primary High Risk HPV Testing with Cyctology TriagePHEScreening
1) Primary testing for high-risk HPV will replace cytology-based screening as the initial test in the NHS cervical screening program. Women who test positive for high-risk HPV will receive cytology triage, while HPV-negative women will be returned to routine recall.
2) A large trial showed primary HPV testing improved sensitivity over cytology alone. A pilot of primary HPV testing confirmed benefits and informed clinical protocols.
3) Women will receive results and follow-up management based on HPV and cytology results, with longer recall for HPV-negative women and colposcopy referral for HPV-positive women with abnormal cytology.
The document discusses breast cancer screening and overdiagnosis. It analyzes data on breast cancer incidence rates in the US from 1976 to 2008. The analysis shows that mammography screening has doubled the number of early-stage breast cancers detected each year, but decreased late-stage cancer cases by only 8%. This suggests that screening may be overdiagnosing breast cancer, detecting some cases that would never have caused harm. While screening increases early detection, it only marginally reduces the rate of women being diagnosed with advanced cancer. The results indicate that breast cancer may be overdiagnosed and screening has only a small effect on reducing mortality from the disease.
Briefing Note: Cervical Cancer Screening in the Gwassi Division, Suba Distric...sarahsteklov
A briefing note on cervical cancer screening practices in the Gwassi Division, Suba District, Nyanza Province, Kenya. Includes WHO guidelines, a pilot study in a neighboring region and interview and survey data from the community.
This document provides updated guidelines for healthcare providers on managing menopause in asymptomatic healthy women and women with menopausal symptoms. It presents lifestyle interventions, medications, and complementary therapies for treating menopausal symptoms according to their efficacy. It also reviews counselling strategies for sexuality concerns during peri- and postmenopause. Approaches to identifying and treating osteoporosis risk are presented in a companion guideline. The guidelines are based on a literature review of recent clinical practice guidelines, randomized controlled trials, observational studies, and other sources.
This document discusses cancer screening. It defines screening as testing asymptomatic individuals at regular intervals to detect cancer early. The goals of screening are to detect cancer early to prevent death and suffering while using minimal treatment. For screening to be effective, the disease must have a detectable preclinical phase and early treatment must improve outcomes. Screening can detect cancer earlier and allow less invasive treatment, but also has risks like overdiagnosis and false positives. Proper evaluation of screening programs is important to understand outcomes and costs. Guidelines recommend screening for breast, cervical and prostate cancers in average risk individuals.
Deborah K. Armstrong, M.D., explains the newly-released patient guide for ovarian cancer patients, which was sponsored by the National Ovarian Cancer Coalition (NOCC).
Dr Ayman Ewies - Prevalence of hyperplasia and cancer in endometrial polyps i...AymanEwies
This document summarizes a study that aimed to quantify the prevalence of hyperplasia and cancer in endometrial polyps among women with postmenopausal bleeding (PMB). The study conducted a systematic review and meta-analysis of 10 studies and found an overall prevalence of hyperplasia and cancer of 8.9%. However, there remains uncertainty around the exact prevalence due to heterogeneity in prior studies. There is also no consensus on whether polyps should be routinely removed or if expectant management could be adopted in some cases. Future research with large prospective studies is needed to help guide clinical practice.
The document summarizes the key findings and implications of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). The trial found that for men with low-risk prostate cancer, radical prostatectomy did not provide a benefit over observation in reducing mortality rates. This suggests that observation may be a reasonable option for some low-risk prostate cancer patients over age 60. However, the trial also implied that radical prostatectomy may provide survival benefits for those with higher-risk disease. The document discusses several limitations of the PIVOT trial and ongoing debates around the management and treatment of localized prostate cancer.
This document discusses cancer screening and provides statistics and information about cancer incidence, mortality, prevalence, and screening. It notes that screening aims to detect cancer early through routine tests when it may be easier to treat. The benefits of screening include finding cancers before symptoms appear and improving survival rates, but there are also risks like false positives requiring additional testing and overdiagnosis. The document provides data on the most common cancers and mortality rates in the UK, as well as trends in cervical cancer mortality following the introduction of screening. It outlines the criteria for effective screening tests and examples of cancers currently screened for in clinical practice like breast, cervical, and colorectal cancers.
The document discusses controversies surrounding breast cancer screening guidelines. It summarizes criticisms of screening mammography from the US Preventive Services Task Force and Swiss Medical Board, including concerns about overdiagnosis and limited survival benefits. It also reviews controversial studies that have influenced guidelines, such as ones finding mammography has low sensitivity especially for dense breasts and limited benefits from screening women in their 40s. Guidelines recommending less frequent screening are criticized for failing to account for tumor growth rates. Overall, the document examines ongoing debates around breast cancer screening recommendations.
The document provides information on developing clinical guidelines for prostate cancer screening using PSA testing. It includes requirements for effective screening programs, characteristics of the PSA test, results from two large randomized controlled trials (PLCO and ERSPC) on PSA screening, and considerations for formulating a screening guideline. A third summary discusses estimates of lead time and overdiagnosis from prostate cancer screening from three mathematical models, with lead times ranging from 5-7 years and overdiagnosis estimated at 23-42% of screen-detected cancers.
Pros and cons of prostate cancer screening by mungai ngugiKesho Conference
1) Prostate cancer screening can have both benefits and harms. The benefits include reducing mortality from prostate cancer by detecting it at an early stage, but screening also commonly results in false positives.
2) Common harms of screening include overdiagnosis where cancers are detected that would never have caused harm, false positives which can lead to invasive biopsies, and potential complications from treatment of screen-detected cancers including incontinence and erectile dysfunction.
3) Guidelines from organizations disagree on screening recommendations for men of different ages, but shared decision making is encouraged to weigh the benefits and harms based on individual risk factors and preferences.
HPV primary Screening is an tempting option for health providers and patients because the results are not subject to inter-observer variation. HPV screening might become cheaper than cytology in the future. Costs of Human resources HPV primary screening is an attractive option to health service managers because the results are not subject to inter-observer variation. Future HPV screening might be cheaper than cytology. Human resources and quality controling means might become even lower.
Nevertheless, HPV testing also requires equipment, reagents, training, quality control and accreditation - and sensitivity and specificity of different HPV tests is known to vary costs quality control may be lower.
Nevertheless, HPV testing also requires equipment, reagents, training, quality control and accreditation - and sensitivity and specificity of different HPV tests is known to vary
Evolving recommendations in prostate cancer screeningsummer elmorshidy
Prostate cancer screening recommendations have evolved as more evidence has emerged. Early approaches recommended annual PSA screening for all men over 50, but two large trials had conflicting results. One found no mortality benefit, while the other found a 21% reduction in men aged 55-69. However, significant overdiagnosis and harms were recognized, including false positives in 75% of biopsied men. Current guidelines recommend shared decision making for screening in men 55-69 and against screening for other age groups. Improved tests are still needed to better distinguish indolent from aggressive cancers.
The document provides recommendations for investigating breast complaints and diagnosing breast diseases and cancer in British Columbia. Key recommendations include screening for breast cancer as per BC Cancer Agency guidelines, taking a full family history to assess genetic risk and referring to the Hereditary Cancer Program when appropriate, using core biopsy as the standard to establish a histological diagnosis, and using diagnostic ultrasound as the initial investigation for women under 30 or who are pregnant/lactating with breast symptoms, and using mammogram and ultrasound as initial tests for women 30 and over. Differential diagnoses of common breast diseases are also listed.
This document summarizes several breast cancer risk assessment models. It discusses two main types of risk assessment: the chances of developing breast cancer over time, and the chances of carrying a mutation in a high-risk gene like BRCA1/2. Several models are described that assess these risks, including the Gail model, Claus model, BRCAPRO, and Cuzick-Tyrer models. Each model incorporates different sets of risk factors and has varying levels of validation and ability to predict cancer risk. The document advocates that improved models integrating more genetic and lifestyle risk factors could achieve more accurate individualized risk prediction.
This document provides recommendations for breast cancer screening. It recommends mammography every 2 years for women aged 50 to 74, as mammography is the recommended screening method for average risk women. It also provides guidance for higher risk women, such as those with a family history or biopsy results showing increased risk. The recommendations are based on evidence regarding breast cancer risk factors like age, heredity, biopsy history, chest radiation, and breast density. Screening aims to balance benefits and risks, such as false positives and radiation exposure.
- Breast cancer screening provides an opportunity to assess cardiovascular risk by reporting breast arterial calcifications (BAC) seen on mammograms. BAC has been associated with increased risk of coronary artery disease.
- Radiologists are encouraged to universally report any seen BAC and include language on the association with cardiovascular risk and the need for further discussion on lifestyle and medical prevention. Some patients are interested to know if BAC is present.
- Accurate assessment of individual breast cancer risk beyond age could help identify women who may benefit from supplemental screening like MRI. Risk models may be enhanced through integration with artificial intelligence applied to mammographic features.
Screening for prostate cancer remains controversial due to the high risk of overdiagnosis and overtreatment. While screening can find early-stage cancers, most prostate cancers grow slowly and will not cause harm. Screening often leads to unnecessary biopsies, treatments and side effects like impotence and incontinence without clear benefits. Younger, low-risk men are unlikely to benefit from PSA screening, while older men or those at higher risk may benefit if screening finds aggressive cancers early. Active surveillance is often preferred over immediate treatment for low-risk prostate cancers found by screening. Overall, more research is still needed to determine which men would benefit most from prostate cancer screening.
This document summarizes a study analyzing media coverage of updated prostate cancer screening guidelines from the USPSTF and AUA. The study found that:
1) 92 news articles were analyzed from 2011-2013 covering the preliminary 2011 USPSTF guidelines, final 2012 guidelines, and 2013 AUA guidelines.
2) Articles frequently emphasized potential downsides of screening and inaccurately summarized guidelines/evidence.
3) Coverage of the USPSTF announcements was more extensive than the AUA guidelines.
4) Urologists were commonly interviewed but articles also cited costs and urologists' financial interests in screening.
5) The study provides insight into how media shapes views of
Advancing The Prevention And Cure Of Cancerfondas vakalis
The document discusses the shared missions and collaborations between the American Association for Cancer Research (AACR) and the National Cancer Institute (NCI) to advance cancer research and reduce the burden of cancer. It outlines their joint efforts in conferences, workshops, and think tanks. It also summarizes advances in cancer prevention, early detection, and treatment that have contributed to reduced cancer mortality rates in recent years but challenges remain.
This study assessed the knowledge of Saudi female university students regarding cervical cancer and acceptance of the HPV vaccine. It found their overall knowledge about cervical cancer risk factors, clinical presentation, Pap smears, and the HPV vaccine was poor. Specifically, 96% of students had a total knowledge score below 60%, demonstrating misinformation about prevention. However, senior and medical students had significantly higher knowledge. While most found the HPV vaccine acceptable if affordable, over half cited concerns about side effects as a reason for refusal. The results provide a baseline for developing effective awareness programs to improve knowledge.
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
This presentation talks about the nonconventional ways to look for cancer. It discusses next generation sequencing for multilane panels for cancer predisposition syndromes, whole genome sequencing, circulating tumor cells, circulating tumor DNA, and CancerSEEK. It also discusses the traditional cancer screening guidelines by the American Cancer Society and the USPSTF.
This document provides recommendations from the Canadian Task Force on Preventive Health Care for screening for cervical cancer. It recommends:
- Screening asymptomatic women aged 25-69 with a Pap test every 3 years, as there is evidence this reduces cervical cancer rates.
- Not routinely screening women under 20, as incidence is very low in this age group and there are potential harms.
- A weak recommendation against routinely screening women aged 20-24, and a weak recommendation for screening women aged 25-29 every 3 years, as benefits are uncertain for these groups while risks of false positives are higher.
- It considered evidence on screening effectiveness, harms, and the current epidemiology and understanding of cervical cancer and HPV to
This document provides guidelines and recommendations for breast cancer screening. It discusses that breast cancer is the most commonly diagnosed cancer in women and the second leading cause of cancer death in women. Screening through mammography can effectively reduce breast cancer mortality. Current guidelines recommend annual mammography screening beginning at age 40, as well as regular clinical breast exams. Newer screening technologies such as digital mammography and MRI for high-risk women are discussed. The importance of breast self-awareness over formal breast self-exam is also highlighted.
This document discusses screening for various gynecological cancers. It provides details about:
1. Screening for cervical cancer, noting the success of the Pap smear in reducing cervical cancer rates. It recommends screening with HPV testing, cytology, or VIA starting at age 30.
2. Screening for ovarian cancer, stating there is currently no role for organized screening but screening high risk women with CA-125 and ultrasound can be considered.
3. Screening for endometrial cancer is not routinely recommended due to a lack of evidence supporting its effectiveness in asymptomatic women.
Dr Ayman Ewies - Prevalence of hyperplasia and cancer in endometrial polyps i...AymanEwies
This document summarizes a study that aimed to quantify the prevalence of hyperplasia and cancer in endometrial polyps among women with postmenopausal bleeding (PMB). The study conducted a systematic review and meta-analysis of 10 studies and found an overall prevalence of hyperplasia and cancer of 8.9%. However, there remains uncertainty around the exact prevalence due to heterogeneity in prior studies. There is also no consensus on whether polyps should be routinely removed or if expectant management could be adopted in some cases. Future research with large prospective studies is needed to help guide clinical practice.
The document summarizes the key findings and implications of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). The trial found that for men with low-risk prostate cancer, radical prostatectomy did not provide a benefit over observation in reducing mortality rates. This suggests that observation may be a reasonable option for some low-risk prostate cancer patients over age 60. However, the trial also implied that radical prostatectomy may provide survival benefits for those with higher-risk disease. The document discusses several limitations of the PIVOT trial and ongoing debates around the management and treatment of localized prostate cancer.
This document discusses cancer screening and provides statistics and information about cancer incidence, mortality, prevalence, and screening. It notes that screening aims to detect cancer early through routine tests when it may be easier to treat. The benefits of screening include finding cancers before symptoms appear and improving survival rates, but there are also risks like false positives requiring additional testing and overdiagnosis. The document provides data on the most common cancers and mortality rates in the UK, as well as trends in cervical cancer mortality following the introduction of screening. It outlines the criteria for effective screening tests and examples of cancers currently screened for in clinical practice like breast, cervical, and colorectal cancers.
The document discusses controversies surrounding breast cancer screening guidelines. It summarizes criticisms of screening mammography from the US Preventive Services Task Force and Swiss Medical Board, including concerns about overdiagnosis and limited survival benefits. It also reviews controversial studies that have influenced guidelines, such as ones finding mammography has low sensitivity especially for dense breasts and limited benefits from screening women in their 40s. Guidelines recommending less frequent screening are criticized for failing to account for tumor growth rates. Overall, the document examines ongoing debates around breast cancer screening recommendations.
The document provides information on developing clinical guidelines for prostate cancer screening using PSA testing. It includes requirements for effective screening programs, characteristics of the PSA test, results from two large randomized controlled trials (PLCO and ERSPC) on PSA screening, and considerations for formulating a screening guideline. A third summary discusses estimates of lead time and overdiagnosis from prostate cancer screening from three mathematical models, with lead times ranging from 5-7 years and overdiagnosis estimated at 23-42% of screen-detected cancers.
Pros and cons of prostate cancer screening by mungai ngugiKesho Conference
1) Prostate cancer screening can have both benefits and harms. The benefits include reducing mortality from prostate cancer by detecting it at an early stage, but screening also commonly results in false positives.
2) Common harms of screening include overdiagnosis where cancers are detected that would never have caused harm, false positives which can lead to invasive biopsies, and potential complications from treatment of screen-detected cancers including incontinence and erectile dysfunction.
3) Guidelines from organizations disagree on screening recommendations for men of different ages, but shared decision making is encouraged to weigh the benefits and harms based on individual risk factors and preferences.
HPV primary Screening is an tempting option for health providers and patients because the results are not subject to inter-observer variation. HPV screening might become cheaper than cytology in the future. Costs of Human resources HPV primary screening is an attractive option to health service managers because the results are not subject to inter-observer variation. Future HPV screening might be cheaper than cytology. Human resources and quality controling means might become even lower.
Nevertheless, HPV testing also requires equipment, reagents, training, quality control and accreditation - and sensitivity and specificity of different HPV tests is known to vary costs quality control may be lower.
Nevertheless, HPV testing also requires equipment, reagents, training, quality control and accreditation - and sensitivity and specificity of different HPV tests is known to vary
Evolving recommendations in prostate cancer screeningsummer elmorshidy
Prostate cancer screening recommendations have evolved as more evidence has emerged. Early approaches recommended annual PSA screening for all men over 50, but two large trials had conflicting results. One found no mortality benefit, while the other found a 21% reduction in men aged 55-69. However, significant overdiagnosis and harms were recognized, including false positives in 75% of biopsied men. Current guidelines recommend shared decision making for screening in men 55-69 and against screening for other age groups. Improved tests are still needed to better distinguish indolent from aggressive cancers.
The document provides recommendations for investigating breast complaints and diagnosing breast diseases and cancer in British Columbia. Key recommendations include screening for breast cancer as per BC Cancer Agency guidelines, taking a full family history to assess genetic risk and referring to the Hereditary Cancer Program when appropriate, using core biopsy as the standard to establish a histological diagnosis, and using diagnostic ultrasound as the initial investigation for women under 30 or who are pregnant/lactating with breast symptoms, and using mammogram and ultrasound as initial tests for women 30 and over. Differential diagnoses of common breast diseases are also listed.
This document summarizes several breast cancer risk assessment models. It discusses two main types of risk assessment: the chances of developing breast cancer over time, and the chances of carrying a mutation in a high-risk gene like BRCA1/2. Several models are described that assess these risks, including the Gail model, Claus model, BRCAPRO, and Cuzick-Tyrer models. Each model incorporates different sets of risk factors and has varying levels of validation and ability to predict cancer risk. The document advocates that improved models integrating more genetic and lifestyle risk factors could achieve more accurate individualized risk prediction.
This document provides recommendations for breast cancer screening. It recommends mammography every 2 years for women aged 50 to 74, as mammography is the recommended screening method for average risk women. It also provides guidance for higher risk women, such as those with a family history or biopsy results showing increased risk. The recommendations are based on evidence regarding breast cancer risk factors like age, heredity, biopsy history, chest radiation, and breast density. Screening aims to balance benefits and risks, such as false positives and radiation exposure.
- Breast cancer screening provides an opportunity to assess cardiovascular risk by reporting breast arterial calcifications (BAC) seen on mammograms. BAC has been associated with increased risk of coronary artery disease.
- Radiologists are encouraged to universally report any seen BAC and include language on the association with cardiovascular risk and the need for further discussion on lifestyle and medical prevention. Some patients are interested to know if BAC is present.
- Accurate assessment of individual breast cancer risk beyond age could help identify women who may benefit from supplemental screening like MRI. Risk models may be enhanced through integration with artificial intelligence applied to mammographic features.
Screening for prostate cancer remains controversial due to the high risk of overdiagnosis and overtreatment. While screening can find early-stage cancers, most prostate cancers grow slowly and will not cause harm. Screening often leads to unnecessary biopsies, treatments and side effects like impotence and incontinence without clear benefits. Younger, low-risk men are unlikely to benefit from PSA screening, while older men or those at higher risk may benefit if screening finds aggressive cancers early. Active surveillance is often preferred over immediate treatment for low-risk prostate cancers found by screening. Overall, more research is still needed to determine which men would benefit most from prostate cancer screening.
This document summarizes a study analyzing media coverage of updated prostate cancer screening guidelines from the USPSTF and AUA. The study found that:
1) 92 news articles were analyzed from 2011-2013 covering the preliminary 2011 USPSTF guidelines, final 2012 guidelines, and 2013 AUA guidelines.
2) Articles frequently emphasized potential downsides of screening and inaccurately summarized guidelines/evidence.
3) Coverage of the USPSTF announcements was more extensive than the AUA guidelines.
4) Urologists were commonly interviewed but articles also cited costs and urologists' financial interests in screening.
5) The study provides insight into how media shapes views of
Advancing The Prevention And Cure Of Cancerfondas vakalis
The document discusses the shared missions and collaborations between the American Association for Cancer Research (AACR) and the National Cancer Institute (NCI) to advance cancer research and reduce the burden of cancer. It outlines their joint efforts in conferences, workshops, and think tanks. It also summarizes advances in cancer prevention, early detection, and treatment that have contributed to reduced cancer mortality rates in recent years but challenges remain.
This study assessed the knowledge of Saudi female university students regarding cervical cancer and acceptance of the HPV vaccine. It found their overall knowledge about cervical cancer risk factors, clinical presentation, Pap smears, and the HPV vaccine was poor. Specifically, 96% of students had a total knowledge score below 60%, demonstrating misinformation about prevention. However, senior and medical students had significantly higher knowledge. While most found the HPV vaccine acceptable if affordable, over half cited concerns about side effects as a reason for refusal. The results provide a baseline for developing effective awareness programs to improve knowledge.
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
This presentation talks about the nonconventional ways to look for cancer. It discusses next generation sequencing for multilane panels for cancer predisposition syndromes, whole genome sequencing, circulating tumor cells, circulating tumor DNA, and CancerSEEK. It also discusses the traditional cancer screening guidelines by the American Cancer Society and the USPSTF.
This document provides recommendations from the Canadian Task Force on Preventive Health Care for screening for cervical cancer. It recommends:
- Screening asymptomatic women aged 25-69 with a Pap test every 3 years, as there is evidence this reduces cervical cancer rates.
- Not routinely screening women under 20, as incidence is very low in this age group and there are potential harms.
- A weak recommendation against routinely screening women aged 20-24, and a weak recommendation for screening women aged 25-29 every 3 years, as benefits are uncertain for these groups while risks of false positives are higher.
- It considered evidence on screening effectiveness, harms, and the current epidemiology and understanding of cervical cancer and HPV to
This document provides guidelines and recommendations for breast cancer screening. It discusses that breast cancer is the most commonly diagnosed cancer in women and the second leading cause of cancer death in women. Screening through mammography can effectively reduce breast cancer mortality. Current guidelines recommend annual mammography screening beginning at age 40, as well as regular clinical breast exams. Newer screening technologies such as digital mammography and MRI for high-risk women are discussed. The importance of breast self-awareness over formal breast self-exam is also highlighted.
This document discusses screening for various gynecological cancers. It provides details about:
1. Screening for cervical cancer, noting the success of the Pap smear in reducing cervical cancer rates. It recommends screening with HPV testing, cytology, or VIA starting at age 30.
2. Screening for ovarian cancer, stating there is currently no role for organized screening but screening high risk women with CA-125 and ultrasound can be considered.
3. Screening for endometrial cancer is not routinely recommended due to a lack of evidence supporting its effectiveness in asymptomatic women.
The document provides updated guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP) for managing abnormal cervical cancer screening tests and cervical precancer. Key changes include new screening guidelines, management of HPV-positive women under 30, and updated recommendations for evaluating cytological abnormalities, cervical precancer, and histopathological diagnoses. The guidelines are based on evidence from over 1 million women and aim to help clinicians better manage cervical cancer screening and precancer treatment.
This document summarizes evidence on screening for prostate cancer with the prostate-specific antigen (PSA) test. It finds that PSA screening can result in a small reduction in prostate cancer mortality but no reduction in all-cause mortality. The harms of screening include false-positive results in 11.3-19.8% of men screened, and complications from unnecessary biopsies and treatments in those with slow-growing cancers that would not have caused symptoms. While one large trial found a benefit, the evidence is uncertain due to variations between study sites and high rates of screening in the control groups of trials.
Management and prevention of cervical cancer.pptxAmin Badamosi
The document provides an overview of cervical cancer including:
- It is the 4th most common cancer in women worldwide and is caused by HPV infection.
- Risk factors include early sexual activity, multiple partners, smoking, and immunosuppression.
- Prevention involves HPV vaccines and screening like Pap tests or HPV tests. Abnormal results may require further tests or treatment.
- Stages of cervical cancer are described along with management approaches like surgery, radiation, or chemotherapy depending on the stage. Recurrence is managed based on prior treatment and extent of disease. The goal is elimination of cervical cancer as a public health problem by 2030.
The document discusses guidelines for cervical cancer screening, including incorporating HPV testing. It finds that HPV testing for women over 30 with ASCUS can reduce unnecessary colposcopies by identifying HPV-negative patients with very low risk. However, HPV testing also poses problems like increased anxiety and many HPV-positive women referred for colposcopy having normal results. Overall, HPV testing may help triage some abnormal pap results but also adds new issues to consider.
The document provides guidelines from the American Cancer Society and US Preventive Services Task Force for cancer screening in average-risk asymptomatic individuals. It discusses screening recommendations for breast, colorectal, cervical, lung and prostate cancer. For each cancer, it summarizes the guidelines from both organizations, noting areas of agreement and differences in their recommendations for when to begin screening, screening intervals, and when to stop screening.
Quantum Medical Update is a CME initiative produced by the in-house clinical team of Quantum Diagnostics. This monthly newsletter is in-line with our commitment to better service our doctors.
The document discusses various options for cervical cancer screening including conventional Pap smears, liquid based cytology, and several HPV testing assays. It emphasizes that HPV testing is more sensitive than cytology alone in detecting cervical lesions. HPV co-testing or HPV testing alone are recommended, with triage of positive HPV tests by genotyping. Liquid based cytology allows for both cytology and HPV testing from a single sample. Algorithms are provided for HPV testing in primary screening and for cytology with HPV co-testing. A table compares the available cervical cancer screening tests offered.
The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. http://docturs.com/dd/pg/groups/2392/cervical-smear-test-pap-test/
The document discusses screening for ovarian cancer. It provides guidelines from BGCS and NICE regarding screening recommendations for average and high-risk women. It summarizes a large study that found annual screening with CA-125 and transvaginal ultrasound (multimodal screening) increased early-stage cancer detection but did not reduce mortality. Therefore, general population screening is not recommended. For high-risk women, screening may be considered after discussing risks and benefits. Recent advances like liquid biopsies and analyzing the MUC16 gene show promise but require more research before implementing.
This document summarizes research on effective interventions for managing primary breast cancer. Key points include:
- Triple assessment (clinical exam, mammography, and biopsy) accurately diagnoses breast cancer in 95-100% of cases and reduces unnecessary biopsies.
- Mastectomy and breast-conserving surgery have similar survival rates, but breast-conserving surgery leads to better preservation of body image.
- Adjuvant therapies like tamoxifen, chemotherapy, and ovarian ablation improve survival and recurrence rates for most patients and are highly cost-effective.
- Patients experience less anxiety when given full verbal and written information about their condition and treatment options. However, doctors may overestimate how much they communicate.
This study aimed to develop a predictive tool for unplanned cesarean delivery (CD) in nulliparous women using prenatal maternal and fetal characteristics. Over 2,200 nulliparous women were prospectively studied across seven Irish hospitals. Multivariate analysis identified that maternal age, BMI, height, fetal abdominal circumference, and head circumference can predict CD risk. A nomogram was developed and showed good predictive ability, with an AUC of 0.69. The tool may help counsel women on their chances of a vaginal delivery versus an elective CD.
The document summarizes updated systematic reviews of interventions to increase screening for breast, cervical, and colorectal cancers. Nine interventions were reviewed: group education, one-on-one education, client reminders, reducing out-of-pocket costs, reducing structural barriers, and provider assessment and feedback. New recommendations were made for group education to increase mammography screening and one-on-one education to increase colorectal cancer screening with FOBT. Evidence for the effectiveness of client reminders to increase FOBT screening was upgraded. Previous findings on the other interventions were reaffirmed. Research gaps in increasing screening, especially for colorectal cancer, were also identified.
CA-125 is a protein marker that is elevated in many ovarian cancer patients. While it returns a true positive result in only 50% of stage I ovarian cancer, serial CA-125 testing over time can achieve a high specificity of 99.6%. Combining CA-125 testing with transvaginal ultrasound and examination increases accuracy for detection. HE4 is another protein marker that is elevated in epithelial ovarian cancer and not benign gynecological conditions. Using both CA-125 and HE4 tests in an algorithm called ROMA can help determine likelihood of malignancy in women with ovarian masses, outperforming CA-125 alone. ROMA and ultrasound are useful first-line tests to select high risk patients for referral and further diagn
Original StudyType of Breast Cancer Diagnosis, Screening,a.docxvannagoforth
Original Study
Type of Breast Cancer Diagnosis, Screening,
and Survival
Carla Cedolini,1 Serena Bertozzi,1 Ambrogio P. Londero,2 Sergio Bernardi,3,4
Luca Seriau,1 Serena Concina,1 Federico Cattin,1 Andrea Risaliti1
Abstract
Organized, invitational breast cancer screening in our population succeeded in detecting early-stage tumors,
which have been consequently treated more frequently with breast and axillary conservative surgery, com-
plementary breast irradiation, and eventual hormonal therapy. The diagnosis of invasive cancer with screening
in our population resulted in a survival gain at 5 years from the diagnosis.
Introduction: Breast cancer screening is known to reduce mortality. In the present study, we analyzed the prevalence
of breast cancers detected through screening, before and after introduction of an organized screening, and we
evaluated the overall survival of these patients in comparison with women with an extrascreening imaging-detected
breast cancer or those with palpable breast cancers. Materials and Methods: We collected data about all women
who underwent a breast operation for cancer in our department between 2001 and 2008, focusing on type of tumor
diagnosis, tumor characteristics, therapies administered, and patient outcome in terms of overall survival, and re-
currences. Data was analyzed by R (version 2.15.2), and P < .05 was considered significant. Results: Among the 2070
cases of invasive breast cancer we considered, 157 were detected by regional mammographic screening (group A),
843 by extrascreening breast imaging (group B: 507 by mammography and 336 by ultrasound), and 1070 by extra-
screening breast objective examination (group C). The 5-year overall survival in groups A, B, and C were, respectively,
99% (95% CI, 98%-100%), 98% (95% CI, 97%-99%), and 91% (95% CI, 90%-93%), with a significant difference
between the first 2 groups and the third (P < .05) and a trend between groups A and B (P ¼ .081). Conclusion: The
diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the
diagnosis, but a longer follow-up is necessary to confirm this data.
Clinical Breast Cancer, Vol. 14, No. 4, 235-40 ª 2014 Elsevier Inc. All rights reserved.
Keywords: Breast cancer, Breast cancer screening, Invasive breast cancer, Mammographic screening, Overall survival
Introduction
Because of the detection of early-stage tumors, breast cancer
screening reduced breast cancer mortality in Europe by 25%-31%
in patients who were invited for screening and by 38%-48% in
those who were actually screened during the last decade of the
twentieth century and the first decade of the twenty-first.1 In our
region of Italy, an organized breast cancer screening was firstly intro-
duced in 2005, but despite the high compliance of invited women
1Clinic of Surgery
2Clinic of Obstetrics and Gynecology
University of Udine, Udine, Italy
3Department of Surgery, Ospedale Civile di Latisana, Udine, Italy
4 ...
This study examined risk factors for breast cancer in Senegalese women through a case-control study of 212 breast cancer patients and 424 controls. The results found that a family history of breast cancer, illiteracy, premenopausal status, and unemployment were associated with increased breast cancer risk. Reproductive factors like age of menarche, parity, and breastfeeding history were not associated with risk. The early average age of diagnosis and association with family history suggests a genetic component to breast cancer risk in Senegalese women. However, further genetic investigation was not possible due to financial limitations.
Cervical cancer prevention involves screening programs, proper sampling and reporting techniques, and management of abnormal Pap smear results. Effective screening programs screen women starting at age 30-35 and every 3-5 years until age 65, depending on country. Screening aims to detect precancerous lesions through Pap smears so they can be treated before developing into invasive cancer. Management of abnormal results involves tests like colposcopy and treatment such as cryotherapy or LEEP for higher grade lesions to prevent cancer progression. Regular screening can reduce lifetime cervical cancer risk by over 90% and is critical for prevention.
This document summarizes the updated 2012 consensus guidelines from experts for managing abnormal cervical cancer screening tests and cervical precursors. The experts reviewed literature and data from 1.4 million women to update guidelines established in 2006. Key updates included:
- HPV-negative atypical squamous cells of undetermined significance results should have co-testing repeated at 3 years before returning to routine screening.
- Younger women aged 21-24 need less invasive management, especially for minor abnormalities.
- Post-colposcopy management incorporates co-testing results.
- Endocervical sampling reported as CIN 1 should be managed as CIN 1.
- Unsatisfactory cytology should usually be repeated, even with known HPV
The document summarizes frequently asked questions about the HPV vaccine. The primary target population for vaccination is 11-12 year old females, though it can be given to girls as young as 9. While the vaccine is best administered prior to sexual activity, it can also be given to sexually active women ages 13-26. Pregnant women should not be vaccinated. The vaccine is approved for females ages 9-26, though it may prove beneficial for older women at risk. It does not appear to have therapeutic value for those already infected. Males should not be vaccinated currently. The total cost of vaccination is around $500. The vaccine will be included in the Vaccines for Children Program to help with coverage. Insurance coverage may
Cervical cancer prevention involves screening programs using cervical cytology to detect precancerous lesions and early cancers. Screening guidelines recommend starting screening at age 25-30 and screening every 3-5 years until age 65-70 depending on screening test and risk factors. Abnormal Pap smears are managed based on the degree of abnormality from mild dysplasia to severe dysplasia and cancer as classified by reporting systems like Bethesda. Prevention aims to detect and treat precancerous lesions to prevent progression to invasive cancer.
This document provides updated guidelines from the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology for screening and early detection of cervical cancer. The guidelines are based on evidence reviews and input from multiple working groups and organizations. The new screening recommendations address age-appropriate screening strategies and the use of cytology and HPV testing.
This document discusses human immunodeficiency virus (HIV) infection in obstetrics and gynecology. It covers topics such as HIV transmission, testing methods for HIV and antibodies, antiretroviral treatment regimens, opportunistic infection prophylaxis based on CD4 count, screening for fetal abnormalities, safety of invasive prenatal testing for HIV-positive women on treatment, ultrasound guidelines, and complications of HIV infection and antiretroviral therapy on pregnancy outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
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2. do not apply to women with symptoms of cervical
cancer or previous abnormal test results on cervi-
cal screening (unless they have been cleared to
resume normal screening); to women who have
had complete surgical removal of the cervix; to
women who are immunosuppressed by HIV,
organ transplantation, chemotherapy or chronic
use of corticosteroids; or to women who have lim-
ited life expectancy such that they would not ben-
efit from screening. The recommendations do not
address the management of abnormal test results
or cervical cancer. Furthermore, they do not ad-
dress screening through testing for human papil-
loma virus (HPV), either alone or in combination
with Pap testing. The Canadian Task Force on
Preventive Health Care felt that it was premature
to make recommendations on such screening until
the evidence in this area is further developed.
Methods
The Canadian Task Force on Preventive Health
Care is an independent panel of clinicians and
methodologists that makes recommendations
about clinical manoeuvres aimed at primary and
secondary prevention (www.canadiantaskforce
.ca). Work on each set of recommendations is led
by a workgroup of 2 to 6 members of the task
force. Each workgroup establishes the research
questions and analytical framework for the guide-
line.
The development of these recommendations
was led by a workgroup of 5 members of the
task force, in collaboration with 2 members of
the Pan-Canadian Cervical Screening Initiative
and supported by scientific officers from the
Public Health Agency of Canada.
The workgroup established the research ques-
tions and analytical framework for the guideline
(Appendix 1, available at www.cmaj.ca/lookup
/suppl/doi:10.1503/cmaj.121505/-/DC1), which
were incorporated into the search protocol. The
task force chose to focus on the critically impor-
tant outcomes: incidence of invasive cervical
cancer and mortality. Studies describing only
high-grade cervical abnormalities (i.e., cervical
intraepithelial neoplasia 2 and 3, including carci-
noma in situ) were not used, since these were
considered intermediate outcomes.16
Rates of
these diagnoses are highly variable between age
groups and screening programs,6
and most of
these lesions do not progress to invasive cervical
cancer or lead to death from cervical cancer.12–14
The Evidence Review and Synthesis Centre
at McMaster University (Hamilton, Ontario)
conducted a systematic review of the available
Guidelines
36 CMAJ, January 8, 2013, 185(1)
Age group, yr
Rateper100000women
No.ofwomen
0
2
4
6
8
10
12
14
16
0
200
400
600
800
1000
1200
Cases of cervical cancer Deaths from cervical
cancer
Incidence Mortality
Figure 1: Cases of and deaths from cervical cancer, with associated incidence and mortality (rates per
100 000 women), among Canadian women (2002–2006) by age group. Data are from the Canadian Cancer
Registry and the vital statistics databases at Statistics Canada.
3. evidence according to the final, peer-reviewed
protocol. The task force used the Grading of
Recommendations Assessment, Development
and Evaluation (GRADE) system to determine
the quality of evidence and strength of recom-
mendations (Box 1).17
More information about
the task force’s methods can be found else-
where18
and on the task force’s website (www
.canadiantaskforce.ca/methods-manual-2011.html),
as well as in Appendices 1 and 2 (available at www
.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.121505
/-/DC1).
Recommendations
A summary of the recommendations for clini-
cians and policy-makers is shown in Box 2.
More detailed explanations of the evidence base
of the recommendations are available in Appen-
dix 3 (available at www.cmaj.ca/lookup/suppl
/doi:10.1503/cmaj.121505/-/DC1).
Cytology
The following recommendations refer to cytologic
screening, using either conventional or liquid-based
methods, whether manual or computer-assisted.
Women aged less than 20 years
For women younger than 20 years of age, we
recommend not routinely screening for cervical
cancer. (Strong recommendation; high-quality
evidence.)
Our evidence review did not find any studies
that examined the effectiveness of screening in
women younger than 20 years of age. Instead,
epidemiological estimates were used to deter-
mine the potential (maximum) benefit of screen-
ing for women in this age group.
Although many Canadian women in this age
group undergo screening (42.2% of women aged
18 and 19 years report having undergone screen-
ing at least once within the previous 3 yr),19
the
incidence of cervical cancer for these women is
very low (0.2 cases per 100 000 from 2002 to
2006) (Figure 1). No deaths from cervical cancer
were reported among Canadian women in this
age group between 2002 and 2006 (Figure 1 and
Appendix 4, available at www.cmaj.ca/lookup
/suppl/doi:10.1503/cmaj.121505/-/DC1).
Although it is thought that providing screening
to women in this age group may help prevent death
from cervical cancer at older ages, we identified no
evidence to support this argument. We found no
national Canadian data on the prevalence of abnor-
mal screening results among women in this age
group. However, data from Alberta show that,
between 2006 and 2008, 10% of women who
underwent screening before 20 years of age were
referred for colposcopy, with a potential for harms
such as pain, bleeding or discharge,20
compared
with lower rates of these harms at older ages.9
Data
from British Columbia also show the highest rates
of cytological abnormality among young women.21
Our recommendation is based on a very low
incidence of and mortality due to cervical cancer
in this age group, no studies addressing effective-
ness for this age group, and evidence of minor
harms to about 10% of women who undergo
screening and more serious harms for some
women who go on to further treatment. A strong
recommendation against screening reflects our
judgment that the potential harms of screening for
women in this age group outweigh the benefits.
Women aged 20–29 years
For women aged 20–24 years, we recommend not
routinely screening for cervical cancer. (Weak
recommendation; moderate-quality evidence.)
For women aged 25–29 years, we recommend
routine screening for cervical cancer every
3 years. (Weak recommendation; moderate-
quality evidence.)
We found no evidence assessing the effective-
ness of screening on decreasing mortality for
women in this age group.11
The only study we
found that specifically examined screening for
women aged 20–24 years22
showed that screening
at ages 20–21 years (odds ratio [OR] 1.5, 95%
Guidelines
CMAJ, January 8, 2013, 185(1) 37
Box 1: Grading of recommendations
• Recommendations are graded according to the Grading of
Recommendations Assessment, Development and Evaluation (GRADE)
system.17
GRADE offers 2 strengths of recommendation: strong and weak.
The strength of recommendations is based on the quality of supporting
evidence, the degree of uncertainty about the balance between desirable
and undesirable effects, the degree of uncertainty or variability in values
and preferences, and the degree of uncertainty about whether the
intervention represents a wise use of resources.
• Strong recommendations are those for which the task force is confident that
the desirable effects of an intervention outweigh its undesirable effects
(strong recommendation for an intervention) or that the undesirable effects
of an intervention outweigh its desirable effects (strong recommendation
against an intervention). A strong recommendation implies that most
people will be best served by the recommended course of action.
• Weak recommendations are those for which the desirable effects probably
outweigh the undesirable effects (weak recommendation for an
intervention) or undesirable effects probably outweigh the desirable
effects (weak recommendation against an intervention) but appreciable
uncertainty exists. A weak recommendation implies that most people
would want the recommended course of action, but many would not. For
clinicians, this means they must recognize that different choices will be
appropriate for individual women, and they must help each woman arrive
at a management decision consistent with her own values and preferences.
Policy-making will require substantial debate and involvement of various
stakeholders. Weak recommendations result when the balance between
desirable and undesirable effects is small, the quality of evidence is lower,
and there is more variability in the values and preferences of patients.
• Evidence is graded as high, moderate, low or very low, based on how likely
further research is to change our confidence in the estimate of effect.
4. confidence interval [CI] 1.0–2.4) or 22–24 years
(OR 1.1, 95% CI 0.8–1.5) had no significant
impact on the incidence of cervical cancer at ages
25–29 years. There has been no reduction in mor-
tality due to cervical cancer among women aged
20–24 years in Canada since the 1970s, when
screening became widespread (Appendix 4).
We found little information on the harms of
screening for cervical cancer stratified by age
group. However, the evidence review identified
22 studies that reported test accuracy in precan-
cerous lesions.11
Specificity for precancerous
lesions tends to be lower, and the risk of false-
positive tests higher, for women less than 30
years of age, leading to more unnecessary diag-
nostic and treatment procedures in younger
women.
Rates of abnormal Pap test results are highest
among young women and decrease with age. In
Canada, 9.8% of women aged 20–29 years had
abnormal test results; this number declines to
1.6% for women aged 60–69 years.8
A high-grade
lesion was found in 1.5% of women aged 20–
29 years;8
these women are then referred for col-
poscopy and possible biopsy, and more than 50%
of them will likely receive further treatment. Thus,
there is a high incidence of minor harms9
and the
potential for future early pregnancy loss or prema-
ture labour for women in this age group.23–26
Our recommendation for women aged 20–
24 years not to undergo screening reflects the
low incidence of cervical cancer and associated
mortality in this age group (from 2002–2006,
incidence 1.3 per 100 000 population, mortality
0.2 per 100 000 population [Appendix 4]); the
uncertain benefit of screening for women in this
age group, either immediately or at older ages;
and the higher risk of false-positive test results
(and their associated harms) compared with
older women. We conclude that the harms of
screening for cervical cancer in women aged 20–
24 years outweigh any potential benefits, but we
have assigned a weak recommendation given the
uncertainty of the evidence.
Our recommendation for women aged 25–
29 years to undergo screening shows our concern
for the higher incidence of and mortality due to
cervical cancer in this age group than in younger
women (Appendix 4), which suggests that the
benefit of screening for these women could be
greater. However, the limitations of Pap testing
for these women are similar to those for women
aged 20–24 years. Therefore, we have assigned a
weak recommendation for this age group,
reflecting our concerns about the rate of false-
positive results and the harms of overtreatment.
The weak recommendation implies that,
although most women would want to follow the
recommended course of action, many would not.
Women who place a relatively higher value on
avoiding invasive cervical cancer and a relatively
lower value on the potential harms of screening
will be more likely to choose screening. Therefore,
clinicians should discuss the potential benefits and
harms of screening with their patients and help
each woman make a decision that is consistent
with her values, preferences and exposure to risk.
Women aged 30–69 years
For women aged 30–69 years, we recommend rou-
tine screening for cervical cancer every 3 years.
(Strong recommendation; high-quality evidence.)
National cohort studies show a strong associa-
tion between the introduction of screening and
reduced incidence of cervical cancer.6,27
The effect
of screening on incidence of invasive cervical can-
cer is shown inAppendix 5 (available at www.cmaj
.ca/lookup/suppl/doi:10.1503/cmaj.121505/-/DC1).
A meta-analysis of 12 case–control studies28–39
showed that the odds of having undergone at least 1
Pap test were lower among women with invasive
cervical cancer (OR 0.4, 95% CI 0.3–0.4, Appen-
dix 5) than among women who did not have cervi-
cal cancer. A cohort study with a 3-year follow-up
Guidelines
38 CMAJ, January 8, 2013, 185(1)
Box 2: Summary of recommendations for clinicians and policy-makers
Recommendations are presented for the use of cervical cytology
(Papanicolaou [Pap] tests) for women with no symptoms of cervical
cancer who are or have been sexually active, regardless of sexual
orientation. The recommendations do not apply to women with
symptoms of cervical cancer (e.g., abnormal vaginal bleeding), women
with previous abnormal results on screening (unless they have been
cleared to return to normal screening), women who do not have a cervix
(because of hysterectomy), women who are immunosuppressed (e.g., as
a result of organ transplantation, chemotherapy, chronic corticosteroid
treatment, HIV infection) or women who have limited life expectancy
such that they would not benefit from screening.
The recommendations do not address screening with human papilloma
virus (HPV) testing (alone or in combination with Pap testing). In our
judgment, such a recommendation would be premature until the
evidence in this area is further developed.
Cytology (conventional or liquid-based, manual or computer-assisted)
• For women aged less than 20 years, we recommend not routinely
screening for cervical cancer. (Strong recommendation; high-quality
evidence)
• For women aged 20–24 years, we recommend not routinely screening
for cervical cancer. (Weak recommendation; moderate-quality evidence)
• For women aged 25–29 years, we recommend routine screening for
cervical cancer every 3 years. (Weak recommendation; moderate-
quality evidence)
• For women aged 30–69 years, we recommend routine screening for
cervical cancer every 3 years. (Strong recommendation; high-quality
evidence)
• For women 70 years of age or older who have undergone adequate
screening (i.e., 3 successive negative Pap test results in the last 10 yr),
we recommend that routine screening may stop. For all other women
70 years of age or older, we recommend continued screening until 3
negative test results have been obtained. (Weak recommendation;
low-quality evidence)
5. found that screening was associated with a decrease
in incidence of cervical cancer (relative risk 0.4,
95% CI 0.2–0.6),38
whereas a randomized con-
trolled trial (RCT) from rural India found a non-
significant effect of screening on incidence.40
This
RCT also found a single lifetime cytologic test had
a nonsignificant effect on 8-year mortality (age-
adjusted hazard ratio [HR] 0.9, 95% CI 0.6–1.3).40
In recent Canadian data, the prevalence of
abnormal results among women who have under-
gone screening declined with age and was reported
to be 4.5% between the ages of 30 and 39 years,
3.5% for ages 40–49 years, 2.4% for ages 50–
59 years and 1.6% for ages 60–69 years.8
The pro-
portion of high-grade lesions also declined with
age (Appendix 6, available at www.cmaj.ca
/lookup/suppl/doi:10.1503/cmaj.121505/-/DC1).8
Thus, the rates of biopsy and subsequent treatment
decrease with increasing age, although the rate at
which cancer is detected remains steady after
40 years of age. Pregnancy-related harms become
less important as women complete their
childbearing.
This recommendation places a high value on
the evidence for the effectiveness of screening, as
well as higher cervical cancer incidence and mor-
tality among women in this age group, balanced
against the lower rates of potential harms com-
pared with younger women. The strong recom-
mendation is based on our confidence that the
desirable effects of screening outweigh the unde-
sirable effects and that most women would be best
served by the recommended course of action.
Women aged 70 years or older
For women aged 70 years and older who have
undergone adequate screening (i.e., 3 successive
negative Pap test results in the previous 10
years), we recommend that routine screening
may end. For women aged 70 years and older
who have not undergone adequate screening, we
recommend continued screening until 3 negative
test results have been obtained. (Weak recom-
mendation; low-quality evidence.)
There is little evidence regarding at what age to
stop screening, although other countries have a pol-
icy to stop screening women over the ages of 65
or 70 years given adequate previous screening.41–43
Evidence for the definition of adequate previous
screening is unclear. The US combined societies
report44
acknowledged the lack of evidence and
used a modelling study45
that suggested that, for
women who had not undergone screening, “a few”
screens resulted in extra life expectancy. European
policy advises that 2 tests with negative results are
sufficient.7
Limited evidence suggests that the pro-
tective effect of screening remains strong in women
aged 70 years and older. One study34
reported lower
odds of screening among women in this age group
with cervical cancer (OR 0.4, 95% CI 0.2–0.5),
compared with women who did not have cervical
cancer. A second study35
reported that women aged
65–74 years with invasive cervical cancer had
lower rates of previous screening than women who
did not have cancer (32% v. 40%), but found no
difference among women aged 75 years and older.
Mortality from cervical cancer in Canada
increases with age, as does incidence until ages 40–
44 years, and remains high (Figure 1). Although
there is limited evidence for the benefits of screen-
ing in older women, this is largely because of the
exclusion of this age group from most of the stud-
ies reviewed. The persistent high incidence of and
mortality due to cervical cancer among Canadian
women aged 70 years and older may be due to low
screening rates in older age groups, or may reflect
the incidence of disease among women who have
never undergone screening. Given these possibili-
ties, healthy women in this age group may derive
some benefit from screening if they have not under-
gone adequate screening previously.
The recommendation to end screening at
70 years of age places high value on the limited
evidence that adequate screening until this age
detects early changes and prevents the develop-
ment of invasive cancer, balanced against the evi-
dence of fewer harms to women in this age group.
The recommendation to ensure that women
who have previously not undergone screening do
so places relatively high value on the limited evi-
dence for the effectiveness of screening, on the
persisting incidence and increasing mortality at
older ages, and on the potential to detect and treat
cervical cancer in this age group. That the recom-
mendation is weak implies that the potential bene-
fits of screening should be discussed with each
woman in relation to her individual preferences
and the value she places on the potential reduc-
tions in risk.
Recommended screening interval
Thirteen case–control studies34–39,46–52
and 2 cohort
studies53,54
suggest that screening intervals of
5 years or less appear to offer women substantial
protection against cervical cancer. A greater ben-
efit was seen with shorter intervals in some of
these studies. In the judgment of the task force,
the recommended 3-year interval balances the
small incremental potential for benefit from
shorter intervals against the greater potential for
harm from increased testing and procedures with
more frequent screening. Most countries outside
North America use 3- or 5-year intervals.55
Human papilloma virus testing
Most studies of HPV testing have shown reductions
Guidelines
CMAJ, January 8, 2013, 185(1) 39
8. Guidelines
in precancerous lesions rather than in the incidence
of or mortality due to cervical cancer. Only 2 stud-
ies included in the search have measured these final
outcomes.40,56
One RCT that reported the effective-
ness of HPV testing on reducing the incidence of
and mortality associated with invasive cervical can-
cer and mortality studied the effect of a single life-
time screen among Indian women over 30 years of
age who had previously not undergone screening;
thus, the applicability of its findings to Canadian
women is uncertain.40
A second trial, from Finland,
did not find HPV testing to significantly further
reduce the incidence of cervical cancer.56
Tests for HPV are not currently offered in all
provinces and are more costly than cytologic test-
ing. Although HPV testing may be more sensitive
than cytology,57–59
which could allow for a longer
screening interval and result in fewer tests, there
may be an initial higher incidence of positive test
results requiring follow-up colposcopy. Some
provinces recommend a combination of HPV and
cytologic testing.60,61
Pap testing is already very
effective, and there is some evidence that adding
HPV testing in a cotesting program may provide
a small additional benefit in terms of reducing the
rate of cervical cancer.62
However, there are many
different technologies available for HPV testing,
and there are several ongoing clinical trials that
may clarify the preferable method of incorporat-
ing it into the screening process. Given these
uncertainties, the task force felt it premature to
make a recommendation on the use of HPV test-
ing in screening (either alone or in combination
with Pap testing). However, we will revisit this
issue as new data become available.
Considerations for implementation
Evidence from countries that begin screening at
an older age and with a longer interval between
screens than is usual in Canada suggests that
organized screening is more effective than oppor-
tunistic screening.56,63–66
Some Canadian provinces
have established such programs, and the rest are
developing them.8
Most provinces have recently
revised their guidelines. Previously, some
provinces recommended annual screening start-
ing at early ages, but all have now increased the
starting age and intervals between screens. Doc-
tors in each province will need to consider their
population and resources in applying the task
force’s recommendations.
One randomized trial67
found no significant dif-
ferences in the incidence of or mortality due to cer-
vical cancer between women undergoing conven-
tional cytologic screening (manual reading of
screens) and computer-assisted screening
(computer-assisted reading of screens). Based on
this evidence, either reading technique may be
used for women of any age for whom Pap tests are
recommended. Although no identified studies
compared liquid-based to conventional cytology in
terms of incidence of and mortality due to cervical
cancer, the sensitivity and specificity of liquid-
based and conventional cytology are similar.11
Increased or decreased screening may be ap-
propriate for women with different risk profiles.
Women who have had a complete hysterectomy
for benign disorders no longer need to undergo
screening, whereas women who are immuno-
compromised may benefit from more frequent
screening.7
There is very limited evidence avail-
able as to the benefits of screening among
women who have sex with women; however,
because this group is at risk for cervical cancer,
they should be advised to undergo screening
according to these recommendations.68
We found
no evidence to recommend a specific interval
between first sexual activity (with potential for
HPV infection) and first need for screening, nor
for more frequent screening for women at in-
creased risk owing to multiple sexual partners.
Practitioners should be aware of women’s val-
ues, preferences and beliefs about screening and
discuss these in the context of the potential bene-
fits and harms of the screening process. Certain
subgroups of women are less likely to receive ade-
quate screening, including immigrant groups,69,70
Aboriginal women71
and women with very low
socioeconomic status.69,72
Many women prefer
female health care providers to perform screen-
ing.73–76
In addition, cultural views on screening
may affect a woman’s willingness to undergo the
procedure,77,78
as might misconceptions regarding
Pap testing.79–81
Other factors affecting the willing-
ness to undergo screening include fear, fatalistic
attitudes, embarrassment, fear of pain or discom-
fort, anxiety and stress related to diagnosis, dis-
trust of the health care system and the belief that
screening is not necessary without illness.11
The limited evidence regarding patient prefer-
ences for screening intervals82,83
suggests that
women who are used to undergoing frequent
screening prefer the feeling of security provided
by shorter rather than longer screening intervals,
and that they are concerned that recommenda-
tions for longer intervals between screens are
primarily a means to save costs.84
Therefore, the
potential harms and benefits should be discussed
between patient and provider for informed
decision-making.
Evidence concerning the performance of Pap
tests by different types of health care profession-
als was limited. Our search found only 1 case–
control study,85
which reported that nongynecolo-
gist physicians were twice as likely as
42 CMAJ, January 8, 2013, 185(1)
9. gynecologists to collect unsatisfactory cervical
specimens in a US teaching hospital. However,
results at this centre may not be generalizable. In
the UK, where practice nurses obtain cervical
specimens, better training improved both the
quality of the specimens and policy adherence.86
Suggested performance measures
for implementation
Recommended indicators are designed to measure
Pap testing at the level of individual primary care
practices. Suggested performance measures include
rates of discussion about cervical cancer screening,
actual rates of testing and subsequent follow-up
(Appendix 7, available at www.cmaj.ca/lookup
/suppl/doi:10.1503/cmaj.121505/-/DC1). The inci-
dence of and mortality due to cervical cancer
should continue to be monitored at the provincial,
territorial and national levels.
Economic implications of screening
Most of the economic studies reviewed did not
assess the relative cost-effectiveness of cytologic
or HPV testing alone. Available data from a Cana-
dian economic modelling study87
suggest that
screening with either cytology (every year or every
3 years) or HPV testing (every 3 years) is highly
cost-effective compared with no screening.
Other guidelines
The current guideline differs from previous re-
commendations of the task force in that routine
screening is not recommended for sexually active
women who are less than 25 years of age, and
screening is now explicitly recommended for
women older than 69 years if previous screening
has not been adequately performed. A summary
of the current guideline has been prepared for use
by family physicians and other health care profes-
sionals (Appendix 8, available at www.cmaj.ca
/lookup/suppl/doi:10.1503/cmaj.121505/-/DC1).
A comparison of recommendations for cervi-
cal screening from several other organizations is
in Table 1.15,41–43,88–90
Notably, although the US task
force supported the use of HPV testing for
women 30 years of age and older at 5-year inter-
vals, it noted that the evidence is still evolving
and that this approach may increase the rates of
investigation and overtreatment.
Gaps in knowledge
More research is needed on the effectiveness and
optimal use of HPV screening in decreasing the
incidence of and mortality due to cervical cancer,
the optimum screening interval and the optimal
ages at which to start and stop screening. It
would also be helpful to obtain better informa-
tion concerning how long screening can be
delayed after first sexual activity and whether
women with certain risk profiles require different
screening protocols.
Although there are high rates of “low-grade”
lesions, greatest among women at young ages (i.e.,
age < 30 yr), evidence on the psychological and
pregnancy-related harms of these lesions is lim-
ited. Given the variation in populations and meth-
ods used, it is difficult to draw firm conclusions
from the available data. Canadian population-
based estimates of the downstream harms of treat-
ing precancerous lesions are inadequate to inform
policy, particularly for women in this age group.
Although there is a cohort of younger women
who have received vaccination against HPV,
reducing their risk of infection by 2 of the most
common oncogenic strains of the virus, the vac-
cine is recent and there is currently insufficient
evidence on which to base recommendations for
screening for this group. For now, these women
should continue to undergo screening as per the
recommendations for their age group.
Conclusion
Our recommendations aim to balance the bene-
fits of screening for cervical cancer with its
potential harms for women of different ages.
High-quality evidence for women aged 30–
69 years leads to a strong recommendation for
routine screening. The evidence for the value of
screening and the balance of benefits and harms
for women outside of this age group is unclear,
leading to weaker recommendations for routine
screening (women aged 25–29 yr) and against
screening (women aged 20–24 yr or ≥ 70 yr).
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Affiliations: From the Departments of Family Medicine and
Community Health Sciences (Dickinson), University of Cal-
gary, Calgary, AB; the Public Health Agency of Canada
(Connor Gorber, Tsakonas), Ottawa, Ont.; Department of
Medicine (Tonelli), University of Alberta, Edmonton, AB;
Departments of Internal Medicine and Community Health
Sciences (Singh), University of Manitoba, and Department of
Medical Oncology and Hematology, Cancer Care Manitoba,
Winnipeg, MB; Department of Family Medicine and Com-
munity Health and Epidemiology (Birtwhistle), Queen’s Uni-
versity, Kingston, Ont.; Department of Family Medicine
(Shaw), McMaster University, Hamilton, Ont.; Faculty of
Health Sciences (Joffres), Simon Fraser University, Burnaby,
BC; Department of Family Medicine (Lewin), University of
Ottawa, Ottawa, Ont.; Canadian Partnership Against Cancer
(Mai), Toronto, Ont.; and the Department of Pathology
(McLachlin), Western University, London, Ont.
Contributors: All of the authors made substantial contribu-
tions to the conception and design of the article, the acquisi-
tion, analysis and interpretation of data, drafted the article
and revised it critically for important intellectual content and
approved the final version submitted for publication.
Funding: Funding for the Canadian Task Force on Preventive
Health Care is provided by the Public Health Agency of Canada
and the Canadian Institutes of Health Research. The views of the
funding body have not influenced the content of the guideline;
competing interests have been recorded and addressed. The
views expressed in this article are those of the authors and do not
represent those of the Public HealthAgency of Canada.
Acknowledgements: The authors acknowledge the staff at
the Task Force Office of the Public Health Agency of Canada
(Sue Pollock, who worked on the development of the
research questions and the analytic framework for the
research protocol; Lesley Dunfield, for her work on develop-
ing and implementing the research protocol; and Amanda
Shane for her work on editing the guideline document); the
peer reviewers (both named and anonymous) whose thought-
ful comments helped to improve the quality of this manu-
script (Jon Kerner and Heather Bryant, Canadian Partnership
Against Cancer; Margaret Czesak, Barbara Foster and Gilles
Plourde, Health Canada; Erica Weir, University of Toronto
and Queen’s University; Louise Pelletier, Public Health
Agency of Canada; Robert Nuttall, Canadian Cancer Society;
Chris Del Mar, Bond University; Gina Ogilvie, British
Columbia Centre for Disease Control and University of
British Columbia; and Julietta Patnick, National Health Ser-
vices Cancer Screening Programmes).
Guidelines writing group: James Dickinson, Eva Tsakonas,
Sarah Connor Gorber, Gabriela Lewin, Elizabeth Shaw,
Harminder Singh, Michel Joffres, Richard Birtwhistle,
Marcello Tonelli, Verna Mai and Meg McLachlin.
Guidelines
CMAJ, January 8, 2013, 185(1) 45