(Press-News.org) Studies currently available provide indications and a "hint" that precursors of cervical cancer can be detected and treated earlier, and consequently tumours occur less often, in women who underwent testing for human papillomavirus (HPV). In this context, an HPV test can be used alone or in addition to a Papanicolaou test (Pap smear). However, both screening procedures also carry a risk of harm in the form of unnecessary treatments after testing (over-treatment). This is the result of a final report published by the German Institute for Quality and Efficiency in Health Care (IQWiG) on 24th of January 2012.
HPV testing is not reimbursed by SHI funds
In screening for cervical cancer, the German statutory health insurance (SHI) funds currently offer an annual (cytologic) examination of mucosal cells from a smear taken from the neck of the womb (cervix). This test is called a Pap smear. Since it became known that infection with HPV is the main risk factor for developing cervical cancer, experts have been discussing whether HPV testing is also a suitable screening method or is even superior to a cytologic test.
The SHI funds currently only reimburse HPV testing in exceptional cases, for example, in cases where the result of a Pap smear is unclear. The Federal Joint Committee (G-BA) therefore commissioned IQWiG to assess the benefit of HPV testing in primary screening and also to compare different screening strategies with each other.
Lower rates of cancers and their precursors are independent outcome criteria
Cancer screening is usually assessed by determining whether this procedure demonstrably contributes to the prevention of cancer-related deaths. However, in cervical cancer the fact whether or not fully developed (invasive) tumours occur less often can also be a criterion for a screening benefit. Similar to the case of colon cancer, screening for cervical cancer aims to detect and treat cellular changes (dysplasia) from which a cancerous tumour could develop, as treatment of such (advanced) precursors of cancer is far less burdensome for patients than later treatment of a tumour.
Studies with a total of 235,613 participants included
IQWiG searched for studies comparing primary screening strategies for cervical cancer based on different screening tests: a strategy including HPV testing alone or in combination with cytology-based testing and a strategy including cytology-based testing alone.
Six randomized controlled trials conducted in the United Kingdom, Finland, Sweden, the Netherlands, and Italy were included in the assessment. A total of 235,613 women had been recruited for the studies in order to be examined for precursors of invasive cervical cancer in at least two screening rounds with an interval of at least three years. However, all of these studies were susceptible to bias, which limits their informative value.
Fewer cancer diagnoses in the second screening round
In the assessment IQWiG distinguished between different outcome criteria. The composite outcome "CIN3+" was analysed, which comprises both invasive cervical cancer and advanced precursors of cancer (high grade cervical intraepithelial dysplasia or in-situ cervical cancer, i.e. CIN3/CIS). In addition, the outcomes "invasive cervical cancer"- that is, not just the occurrence of a cancer precursor but of a tumour - as well as "CIN3/CIS" were analysed separately.
In the second screening round, the number of diagnoses for the two outcomes "CIN3+" and "invasive cervical cancer" was lower in the HPV group than in the group of women who had only been examined with a cytology-based screening strategy (e.g. Pap smear) in the first screening round. IQWiG therefore determined an indication of a benefit for these two outcomes.
If solely the advanced precursors of cancer are considered (CIN3/CIS), the data only provide a "hint" of a benefit. This is primarily due to a relatively large study that showed no difference between the HPV group and the comparator group. The new category "hint" expresses that certain minimum requirements for the available studies are fulfilled, but that conclusions on benefit and harm are only of low certainty.
No evaluable data on survival and quality of life
Conclusions on overall survival, mortality related to cervical cancer, and quality of life are not possible, as no data or no evaluable data were available for these outcomes.
Neither were evaluable data on potential screening-related harm available. For instance, unnecessary diagnostic procedures (e.g. biopsies) as a result of false-positive test results may harm patients. Moreover, the diagnosis itself can be a psychological burden, triggering anxieties or feelings of guilt.
Harm can also be caused by over-treatment. It is notable that women with moderate grade (CIN2) or sometimes even low grade cancer precursors were also treated in the included studies; in a great number of cases these precursors regress and only rarely progress into cancer. However, it cannot be estimated on the basis of these studies how often women who underwent HPV testing and/or a Pap smear were subjected to unnecessary treatment.
No recommendation for specific screening strategy possible
The complex screening strategies applied in the studies varied greatly and can therefore hardly be compared with each other. This applies to the participants' age and the intervals between follow-up examinations, as well as to the questions in which sequence or combination the HPV or cytology test should be applied and what measures should be undertaken after certain test results.
The study results therefore do not allow a recommendation for a specific screening strategy in the German health care system. The few common factors of the studies include the fact that the screening interval lasted at least three years and the screening programme was conducted in an organized population-based and quality assured context.
###
Procedure of report production
IQWiG published the preliminary results in the form of the preliminary report in June 2011 and interested parties were invited to submit comments. When the commenting procedure ended, the preliminary report was revised and sent as a final report to the contracting agency, the G-BA, in November 2011. The written comments were published in a separate document at the same time as the final report. The report was produced in collaboration with external experts.
END
As 2011 drew to a close, Representative Al Ott led a coalition of his colleagues to introduce a new domestic violence bill in the Wisconsin State Assembly. Assembly Bill 449 is a bi-partisan measure which seeks to increase the penalties for those with multiple domestic abuse convictions, and make felonies out of some offenses that were formerly only misdemeanor charges.
At the outset of 2012, Assembly Bill 449 has been referred to the Committee on Criminal Justice and Corrections and a companion bill is similarly situated in the Wisconsin Senate. If the measures pass ...
If your boss is giving you a hard time - lying, making fun of you in public and generally putting you down, he or she may benefit from some exercise, according to a new study by James Burton from Northern Illinois University in the US and his team. Their work shows that stressed supervisors, struggling with time pressures, vent their frustrations on their employees less when they get regular, moderate exercise. The research is published online in Springer's Journal of Business and Psychology.
In the current economic climate, it is not unusual to come across stressed supervisors. ...
EPFL scientist are among the leaders in the race to develop an industry-ready prototype of a 3D chip as well as a high-performance and reliable manufacturing method. The chip is composed of three or more processors that are stacked vertically and connected together—resulting in increased speed and multitasking, more memory and calculating power, better functionality and wireless connectivity. Developed at the Microelectronics Systems Laboratory (LSM), Director Yusuf Leblebici is unveiling these results to experts on Wednesday the 25th of January in Paris, in a keynote presentation ...
Thinking about religion gives people more self-control on later, unrelated tasks; according to results from a series of recent Queen's University study.
"After unscrambling sentences containing religiously oriented words, participants in our studies exercised significantly more self-control," says psychology graduate student and lead researcher on the study, Kevin Rounding.
Study participants were given a sentence containing five words to unscramble. Some contained religious themes and others did not. After unscrambling the sentences, participants were asked to complete ...
CAMBRIDGE, Mass. -- MIT postdoc Emile Bruneau has long been drawn to conflict — not as a participant, but an observer. In 1994, while doing volunteer work in South Africa, he witnessed firsthand the turmoil surrounding the fall of apartheid; during a 2001 trip to visit friends in Sri Lanka, he found himself in the midst of the violent conflict between the Tamil Tigers and the Sri Lankan military.
Those chance experiences got Bruneau, who taught high school science for several years, interested in the psychology of human conflict. While teaching, he also volunteered as ...
PROVIDENCE, R.I. – A newly published paper from Rhode Island Hospital reports on the impact to patients if five personality disorders are removed from the upcoming revision to the Diagnostic and Statistical Manual, 5th edition (DSM-5). Based on their study, the researchers believe these changes could result in false-negative diagnoses for patients. The paper is published in the Journal of Clinical Psychiatry and is now available online in advance of print.
The DSM-5 Personality and Personality Disorders work group made several recommendations to change the approach toward ...
COLUMBIA, Mo. – While it may appear that infants are helpless creatures that only blink, eat, cry and sleep, one University of Missouri researcher says that studies indicate infant brains come equipped with knowledge of "intuitive physics."
"In the MU Developmental Cognition Lab, we study infant knowledge of the world by measuring a child's gaze when presented with different scenarios," said Kristy vanMarle, an assistant professor in the Department of Psychological Sciences in the College of Arts and Science. "We believe that infants are born with expectations about the ...
EAST LANSING, Mich. — Prejudice is linked to aggression for men and fear for women, suggests new research led by Michigan State University scholars.
The researchers report that, throughout history, men have been the primary aggressors against different groups as well as the primary victims of group-based aggression and discrimination.
"There is evidence going back thousands of years of bands of men getting together and attacking other bands of men, eliminating them and keeping the women as the spoils of war," said Carlos David Navarrete, evolutionary psychologist at ...
A recently published academic study set out to examine differences in staffing levels and the quality of resident care between for-profit nursing home companies and government-owned facilities. The study, headed by a professor at the University of California-San Francisco's School of Nursing, sheds interesting light on nursing home neglect problems in the U.S.
The study focused on the ten largest nursing home chains in the country, and found that they all had lower staffing hours for registered nurses and other nurses than public facilities. In addition, facilities owned ...
Division of labour is not only a defining feature of human societies but is also omnipresent among the building blocks of biological organisms and is considered a major theme of evolution. Theoretical Biologists Claus Rueffler and Joachim Hermisson from Vienna University in collaboration with Günter P. Wagner from Yale University identified necessary conditions under which division of labour is favoured by natural selection. The results of their study are published in the Proceedings of the National Academy of Sciences (PNAS).
Most animals and plants consist of a set ...
