IMR Press / EJGO / Volume 26 / Issue 4 / pii/2005184

European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on as a courtesy and upon agreement with S.O.G.


Screening for cervical cancer - an evidence-based approach

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1 Department of Medicine E, Rabin Medical Center, Beilinson Campus, Petah-Tikva (Israel)
2 Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah-Tikva (Israel)
3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel)
Eur. J. Gynaecol. Oncol. 2005, 26(4), 372–375;
Published: 10 August 2005

Introduction: The Papanicolau (Pap) smear is widely accepted by both the public and health authorities as a useful tool for detec­tion of cervical cancer and its precursors. In Israel only opportunistic screening exists and still the incidence of invasive cervical cancer is among the lowest in the world. Objectives: To examine the existing evidence for the effectiveness of cervical cancer screening by Pap smears; to apply the find­ings to Israeli data, and to assess the implications for the current cervical cancer screening policy. Methods: Search of Medline (1966-June 2003) and the Cochrane Library for relevant systematic reviews, controlled trials and cohort studies. Results: There have been no trials of screening for cervical cancer and its precursors and therefore, no direct evidence that screen­ing improves outcomes. A single retrospective cohort study estimated the age-adjusted RR for invasive cervical cancer in women with at least one Pap smear, whether normal or abnormal, compared to women with no smear at 0.4 (95% Cl 0.2-0.9). In Israel some 27,800 (range: 20,800-167,000) women need to be screened in order to prevent one case of cervical cancer. The cost of preventing a single case of invasive cervical is approximately 1.288 million NIS (range: 1.643-13.193 million NIS). Conclusions: An evidence-based approach to the question of the effectiveness of cervical cancer screening using Pap smears has yielded weak evidence. Based on this weak evidence and rough estimations of the effectiveness and cost of mass screening for cer­vical cancer in Israel, we conclude that the current policy should be maintained.

Cervical cancer
Evidence-based medicine
Number needed to screen (NNS)
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