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Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies.

Fokom-Domgue J, Combescure C, Fokom-Defo V, Tebeu PM, Vassilakos P, Kengne AP, Petignat P - BMJ (2015)

Bottom Line: Inclusion criteria for studies were: alternative methods to cytology used as a standalone test for primary screening; study population not at particular risk of cervical cancer (excluding studies focusing on HIV positive women or women with gynaecological symptoms); women screened by nurses; reference test (colposcopy and directed biopsies) performed at least in women with positive screening results.Prevalence of CIN2+ did not vary by screening test and ranged from 2.3% (95% confidence interval 1.5% to 3.3%) in VILI studies to 4.9% (2.7% to 7.8%) in HPV testing studies.Implementation studies are needed to assess the effect of these screening strategies on the incidence and outcomes of cervical cancer in the region.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, 1211 Geneva 14, Switzerland fokom.domgue@gmail.com.

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Fig 1 Study flowchart of papers in selection process. *Gold standard performed in all women in the study population. †Gold standard performed in all women with a positive screening result and only a portion of women with a negative screening result. HC2=second generation hybrid capture assay; PICOS=population, intervention (screening tests), comparison (gold standard), outcomes (absolute and relative sensitivity and specificity, prevalence of CIN2+, and positivity rate of tests), study design; PCR=polymerase chain reaction; RCT=randomised controlled trial
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fig1: Fig 1 Study flowchart of papers in selection process. *Gold standard performed in all women in the study population. †Gold standard performed in all women with a positive screening result and only a portion of women with a negative screening result. HC2=second generation hybrid capture assay; PICOS=population, intervention (screening tests), comparison (gold standard), outcomes (absolute and relative sensitivity and specificity, prevalence of CIN2+, and positivity rate of tests), study design; PCR=polymerase chain reaction; RCT=randomised controlled trial

Mentions: Of 1049 entries identified via searches, 15 papers (eight in the GSA group, seven in the GSP group) fulfilled the inclusion criteria193334353637383940414243444546 (fig 1). Two thirds of included papers were from southern (six papers) or eastern (four) Africa. One article reported data from five countries in western and middle Africa;40 we considered them separately. Therefore, the meta-analyses included 15 reports (10 in the GSA group; five in the GSP group) of 61 381 women screened by VIA, eight reports (all GSA) of 46 435 women screened by VILI, and six reports (three GSA; three GSP) of 11 322 women screened by HPV testing (four on second generation hybrid capture assays, one on careHPV, and one on PCR).


Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies.

Fokom-Domgue J, Combescure C, Fokom-Defo V, Tebeu PM, Vassilakos P, Kengne AP, Petignat P - BMJ (2015)

Fig 1 Study flowchart of papers in selection process. *Gold standard performed in all women in the study population. †Gold standard performed in all women with a positive screening result and only a portion of women with a negative screening result. HC2=second generation hybrid capture assay; PICOS=population, intervention (screening tests), comparison (gold standard), outcomes (absolute and relative sensitivity and specificity, prevalence of CIN2+, and positivity rate of tests), study design; PCR=polymerase chain reaction; RCT=randomised controlled trial
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4490835&req=5

fig1: Fig 1 Study flowchart of papers in selection process. *Gold standard performed in all women in the study population. †Gold standard performed in all women with a positive screening result and only a portion of women with a negative screening result. HC2=second generation hybrid capture assay; PICOS=population, intervention (screening tests), comparison (gold standard), outcomes (absolute and relative sensitivity and specificity, prevalence of CIN2+, and positivity rate of tests), study design; PCR=polymerase chain reaction; RCT=randomised controlled trial
Mentions: Of 1049 entries identified via searches, 15 papers (eight in the GSA group, seven in the GSP group) fulfilled the inclusion criteria193334353637383940414243444546 (fig 1). Two thirds of included papers were from southern (six papers) or eastern (four) Africa. One article reported data from five countries in western and middle Africa;40 we considered them separately. Therefore, the meta-analyses included 15 reports (10 in the GSA group; five in the GSP group) of 61 381 women screened by VIA, eight reports (all GSA) of 46 435 women screened by VILI, and six reports (three GSA; three GSP) of 11 322 women screened by HPV testing (four on second generation hybrid capture assays, one on careHPV, and one on PCR).

Bottom Line: Inclusion criteria for studies were: alternative methods to cytology used as a standalone test for primary screening; study population not at particular risk of cervical cancer (excluding studies focusing on HIV positive women or women with gynaecological symptoms); women screened by nurses; reference test (colposcopy and directed biopsies) performed at least in women with positive screening results.Prevalence of CIN2+ did not vary by screening test and ranged from 2.3% (95% confidence interval 1.5% to 3.3%) in VILI studies to 4.9% (2.7% to 7.8%) in HPV testing studies.Implementation studies are needed to assess the effect of these screening strategies on the incidence and outcomes of cervical cancer in the region.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, 1211 Geneva 14, Switzerland fokom.domgue@gmail.com.

Show MeSH
Related in: MedlinePlus