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Systematic Review
To inform updated recommendations by the Canadian Task Force on Preventive Health Care (Task Force) on screening in primary care for the prevention and early detection of cervical cancer in individuals with a cervix who are 15 years or older who have been sexually active and have no symptoms of cervical cancer.
Five types of interventions to improve screening rates for under/never-screened individuals were reviewed. All were found with moderate or high certainty to improve screening rates: written contact (relative risk [RR] 1.50, 95% CI 1.22 to 1.84; 619 more per 10,000, 95% CI 273 to 1041; 16 trials, N = 138,880); personal contact (RR 1.50, 95% CI 1.07 to 2.11; 797 more, 95% CI 1116 to 1770; 7 trials, N = 17,034); composite interventions (usually mixture of written and personal contact; RR 1.73, 95% CI 1.33 to 2.27; 1351 more, 95% CI 610 to 2350; 8 trials, N = 17,738); universal mail-out of hrHPV self-sampling kit (RR 2.56, 95% CI 2.10 to 3.12; 1534 more, 95% CI 1082 to 2085; 22 trials, N = 211,031); and opt-in to receive a hrHPV self-sampling kit (RR 1.56, 95% CI 1.19 to 2.03; 727 more, 95% CI 247 to 1338; 11 trials, N = 71,433).
Most of the studies on screening effects were undertaken in populations either in which HPV vaccination had not been implemented or carried out in a period when vaccination rates were low. For under- or never-screened individuals, the offer of self-sampling kits for hrHPV testing probably improves screening rates without missing an important number of CIN 2/3, but it is uncertain if findings apply in practice when triage to cytology is used because of the need for a clinic visit.
There was low certainty evidence that informed individuals eligible for screening think the benefits outweigh the harms from screening.
Choices for screening strategies apart from cytology alone may result largely from contextual considerations such as access, acceptability, resources, and costs.