Counterpoint: Cervical Cancer Screening Guidelines-Approaching the Golden Age
ABSTRACT Changes in screening guidelines that imply suppression of procedures once recommended are always controversial because of the perception that benefits are being curtailed. Prior to 2012, cervical cancer screening guidelines issued by US-based expert bodies differed in several decision areas, making clinicians essentially cherry-pick among recommendations. To some extent, this approach to screening practices also served to shield clinicians from litigation. It implied starting screening earlier, doing it more frequently, and stopping later in life than necessary. This state of affairs changed in 2012, when the most influential professional groups updated their cervical screening guidelines, and recommendations became essentially unified. All groups recommended that women older than 65 years of age discontinue cervical cancer screening on the basis of evidence that screening benefits in this age group were minor and far outweighed by harms. The guidelines are very specific about the exceptions, which ensure acceptable safety. It is expected that the new guidelines will permit less wasteful cervical screening, while fostering the opportunity to direct resources towards ensuring adequate coverage of high-risk women.
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ABSTRACT: This chapter will review the current modalities available to the clinician to screen for premalignant and malignant cervical lesions, which cast a broad net. The majority who test positive are not destined to suffer from or die from cervical cancer. Many who undergo screening and are triaged are young and subsequently face a number of aggressive and destructive therapies. This calls into question whether higher-risk patients should be managed more aggressively than an average-risk patient represented in the study population used to craft the guidelines.Clinical obstetrics and gynecology 03/2014; DOI:10.1097/GRF.0000000000000026 · 1.53 Impact Factor
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ABSTRACT: Objective To review the literature concerning the role of cervical screening in women 60 years and older Methods Literature review was conducted using Pubmed and the search terms cervical neoplasm, cancer, middle aged, elderly, aged, postmenopausal, cervical cytology and screening. To be included in the review the article must have been in the English language. The search focused on publications from 2000 forward. Results The case control and modeling studies that addressed the role of cervical cytology screening in women 60 and older were reviewed. The outcomes of interest included: 1) the benefits of screening in terms of decrease rate of cervical cancer incidence (6 studies) and mortality (3 studies); 2) the duration of protection of the last screening test (4 studies); and 3) the harms of screening older women including false positive test results and cost. Conclusions Cervical cytology screening is beneficial for women over 60 years in terms of preventing the occurrence and death from cervical cancer. A negative cytology test appears to have 5 years of protection in this age group. Age of last screen with in an organized screening program may differ compared to the goals and wishes of individual women.Maturitas 12/2014; 79(4). DOI:10.1016/j.maturitas.2014.09.012 · 2.86 Impact Factor
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ABSTRACT: Because of the complexity of cervical cancer prevention guidelines, clinicians often fail to follow best-practice recommendations. Moreover, existing clinical decision support (CDS) systems generally recommend a cervical cytology every three years for all female patients, which is inappropriate for patients with abnormal findings that require surveillance at shorter intervals. To address this problem, we developed a decision tree-based CDS system that integrates national guidelines to provide comprehensive guidance to clinicians. Validation was performed in several iterations by comparing recommendations generated by the system with those of clinicians for 333 patients. The CDS system extracted relevant patient information from the electronic health record and applied the guideline model with an overall accuracy of 87%. Providers without CDS assistance needed an average of 1 minute 39 seconds to decide on recommendations for management of abnormal findings. Overall, our work demonstrates the feasibility and potential utility of automated recommendation system for cervical cancer screening and surveillance.Cancer informatics 01/2014; 13(Suppl 3):1-6. DOI:10.4137/CIN.S14035