Screening for Cervical Cancer: Systematic Evidence Review Number 25
Screening for Cervical Cancer: Systematic Evidence Review Number 25
Overview
Since introduction of cytologic screening for cervical cancer using the Papanicolaou (Pap) test in the 1950s, the incidence of invasive cervical cancer in the United States has fallen more than 100%. No other cancer screening program has been more successful. This fall occurred despite an increase in risk factors for cervical cancer, such as younger age at initiation of sexual intercourse, more sexual partners in a lifetime, and greater prevalence of human papilloma virus (HPV) infection and cigarette smoking. Success in prevention reflects three factors: (1) progression from early cellular abnormalities, termed low-grade dysplasia, through more severe dysplasia, to carcinoma in situ and invasive cancer is generally slow, allowing time for detection; (2) associated cellular abnormalities can be identified; and (3) effective treatment is available for premalignant lesions. Consequently, invasive squamous cell carcinoma of the uterine cervix is a highly preventable disease. Introduction of screening programs in populations naïve to screening reduces cervical cancer rates by 60% to 90% within three years of implementation. This reduction of mortality and morbidity with introduction of screening with the Pap test is consistent and dramatic across populations. As a result, Pap testing is one of the few preventive interventions that has received an .A. recommendation from the US Preventive Services Task Force (USPSTF) in the absence of randomized trials demonstrating effectiveness. In the United States, approximately 12,800 new cases of cervical cancer are diagnosed and 4,800 deaths occur each year. Incidence of cervical cancer is decreasing; US rates have decreased from 14.2 new cases per 100,000 women in 1973 to 7.8 per 100,000 in 1994. For each woman with invasive disease, there will be 4 with carcinoma in situ and 10 with cervical dysplasia. Despite falling incidence, cervical cancer remains the ninth most common cause of cancer deaths. Of the cancer prevention goals established in “Healthy People 2000”, including colorectal, lung, and breast cancer, cervical cancer mortality rates were the furthest off target at the mid-course review. The target for cervical cancer was reduction of mortality to 1.3 deaths per 100,000 women; the current rate remains near 2.7 deaths per 100,000, down only slightly from 2.8 per 100,000 in 1987. Detection of cervical cancer in its earliest stages is lifesaving, as survival of cancer of the cervix uteri depends heavily on stage at diagnosis. Although 91.5% of women will survive 5 years when the cancer is localized, only 12.6% will survive distant disease. Our key questions include: Key Question 1: Who should be screened for cervical cancer and how often? Specifically, we asked what are the outcomes (benefits, harms, and costs) associated with screening: 1A. Among women age 65 and older? 1B. Among women who have had a hysterectomy? Key Question 2: To what extent do new methods for preparing or evaluating cervical cytology improve diagnostic yield compared to conventional methods? At what cost (harms and economic)? Key Question 3: What is the role of HPV testing in cervical cancer screening strategies? Specifically: 3A. What are the benefits, harms, and costs of using HPV testing as a screening test, or of incorporating HPV testing at the time of the screening Pap test, compared with not testing for HPV? 3B. What are the benefits, harms, and costs of using HPV testing as part of a screening strategy to determine which women with an abnormal Pap test should receive further evaluation?Description
Condition Guidelines
Books - New and Used
The following guidelines apply to books:
- New: A brand-new copy with cover and original protective wrapping intact. Books with markings of any kind on the cover or pages, books marked as "Bargain" or "Remainder," or with any other labels attached, may not be listed as New condition.
- Used - Good: All pages and cover are intact (including the dust cover, if applicable). Spine may show signs of wear. Pages may include limited notes and highlighting. May include "From the library of" labels. Shrink wrap, dust covers, or boxed set case may be missing. Item may be missing bundled media.
- Used - Acceptable: All pages and the cover are intact, but shrink wrap, dust covers, or boxed set case may be missing. Pages may include limited notes, highlighting, or minor water damage but the text is readable. Item may but the dust cover may be missing. Pages may include limited notes and highlighting, but the text cannot be obscured or unreadable.
Note: Some electronic material access codes are valid only for one user. For this reason, used books, including books listed in the Used – Like New condition, may not come with functional electronic material access codes.
Shipping & Delivery
Shipping Fees
- Stevens Books offers FREE SHIPPING everywhere in the United States for ALL non-book orders, and $3.99 for each book.
- Packages are shipped from Monday to Friday.
- No additional fees and charges.
Delivery Times
The usual time for processing an order is 24 hours (1 business day), but may vary depending on the availability of products ordered. This period excludes delivery times, which depend on your geographic location.
Estimated delivery times:
- Standard Shipping: 5-8 business days
- Expedited Shipping: 3-5 business days
Shipping method varies depending on what is being shipped.
Tracking
All orders are shipped with a tracking number. Once your order has left our warehouse, a confirmation e-mail with a tracking number will be sent to you. You will be able to track your package at all times.
Damaged Parcel
If your package has been delivered in a PO Box, please note that we are not responsible for any damage that may result (consequences of extreme temperatures, theft, etc.).
If you have any questions regarding shipping or want to know about the status of an order, please contact us or email to support@stevensbooks.com.
Returns & Refunds
You may return most items within 30 days of delivery for a full refund.
To be eligible for a return, your item must be unused and in the same condition that you received it. It must also be in the original packaging.
Several types of goods are exempt from being returned. Perishable goods such as food, flowers, newspapers or magazines cannot be returned. We also do not accept products that are intimate or sanitary goods, hazardous materials, or flammable liquids or gases.
Additional non-returnable items:
- Gift cards
- Downloadable software products
- Some health and personal care items
To complete your return, we require a tracking number, which shows the items which you already returned to us.
There are certain situations where only partial refunds are granted (if applicable)
- Book with obvious signs of use
- CD, DVD, VHS tape, software, video game, cassette tape, or vinyl record that has been opened
- Any item not in its original condition, is damaged or missing parts for reasons not due to our error
- Any item that is returned more than 30 days after delivery
Items returned to us as a result of our error will receive a full refund,some returns may be subject to a restocking fee of 7% of the total item price, please contact a customer care team member to see if your return is subject. Returns that arrived on time and were as described are subject to a restocking fee.
Items returned to us that were not the result of our error, including items returned to us due to an invalid or incomplete address, will be refunded the original item price less our standard restocking fees.
If the item is returned to us for any of the following reasons, a 15% restocking fee will be applied to your refund total and you will be asked to pay for return shipping:
- Item(s) no longer needed or wanted.
- Item(s) returned to us due to an invalid or incomplete address.
- Item(s) returned to us that were not a result of our error.
You should expect to receive your refund within four weeks of giving your package to the return shipper, however, in many cases you will receive a refund more quickly. This time period includes the transit time for us to receive your return from the shipper (5 to 10 business days), the time it takes us to process your return once we receive it (3 to 5 business days), and the time it takes your bank to process our refund request (5 to 10 business days).
If you need to return an item, please Contact Us with your order number and details about the product you would like to return. We will respond quickly with instructions for how to return items from your order.
Shipping Cost
We'll pay the return shipping costs if the return is a result of our error (you received an incorrect or defective item, etc.). In other cases, you will be responsible for paying for your own shipping costs for returning your item. Shipping costs are non-refundable. If you receive a refund, the cost of return shipping will be deducted from your refund.
Depending on where you live, the time it may take for your exchanged product to reach you, may vary.
If you are shipping an item over $75, you should consider using a trackable shipping service or purchasing shipping insurance. We don’t guarantee that we will receive your returned item.
Overview
Since introduction of cytologic screening for cervical cancer using the Papanicolaou (Pap) test in the 1950s, the incidence of invasive cervical cancer in the United States has fallen more than 100%. No other cancer screening program has been more successful. This fall occurred despite an increase in risk factors for cervical cancer, such as younger age at initiation of sexual intercourse, more sexual partners in a lifetime, and greater prevalence of human papilloma virus (HPV) infection and cigarette smoking. Success in prevention reflects three factors: (1) progression from early cellular abnormalities, termed low-grade dysplasia, through more severe dysplasia, to carcinoma in situ and invasive cancer is generally slow, allowing time for detection; (2) associated cellular abnormalities can be identified; and (3) effective treatment is available for premalignant lesions. Consequently, invasive squamous cell carcinoma of the uterine cervix is a highly preventable disease. Introduction of screening programs in populations naïve to screening reduces cervical cancer rates by 60% to 90% within three years of implementation. This reduction of mortality and morbidity with introduction of screening with the Pap test is consistent and dramatic across populations. As a result, Pap testing is one of the few preventive interventions that has received an .A. recommendation from the US Preventive Services Task Force (USPSTF) in the absence of randomized trials demonstrating effectiveness. In the United States, approximately 12,800 new cases of cervical cancer are diagnosed and 4,800 deaths occur each year. Incidence of cervical cancer is decreasing; US rates have decreased from 14.2 new cases per 100,000 women in 1973 to 7.8 per 100,000 in 1994. For each woman with invasive disease, there will be 4 with carcinoma in situ and 10 with cervical dysplasia. Despite falling incidence, cervical cancer remains the ninth most common cause of cancer deaths. Of the cancer prevention goals established in “Healthy People 2000”, including colorectal, lung, and breast cancer, cervical cancer mortality rates were the furthest off target at the mid-course review. The target for cervical cancer was reduction of mortality to 1.3 deaths per 100,000 women; the current rate remains near 2.7 deaths per 100,000, down only slightly from 2.8 per 100,000 in 1987. Detection of cervical cancer in its earliest stages is lifesaving, as survival of cancer of the cervix uteri depends heavily on stage at diagnosis. Although 91.5% of women will survive 5 years when the cancer is localized, only 12.6% will survive distant disease. Our key questions include: Key Question 1: Who should be screened for cervical cancer and how often? Specifically, we asked what are the outcomes (benefits, harms, and costs) associated with screening: 1A. Among women age 65 and older? 1B. Among women who have had a hysterectomy? Key Question 2: To what extent do new methods for preparing or evaluating cervical cytology improve diagnostic yield compared to conventional methods? At what cost (harms and economic)? Key Question 3: What is the role of HPV testing in cervical cancer screening strategies? Specifically: 3A. What are the benefits, harms, and costs of using HPV testing as a screening test, or of incorporating HPV testing at the time of the screening Pap test, compared with not testing for HPV? 3B. What are the benefits, harms, and costs of using HPV testing as part of a screening strategy to determine which women with an abnormal Pap test should receive further evaluation?Description
Condition Guidelines
Books - New and Used
The following guidelines apply to books:
- New: A brand-new copy with cover and original protective wrapping intact. Books with markings of any kind on the cover or pages, books marked as "Bargain" or "Remainder," or with any other labels attached, may not be listed as New condition.
- Used - Good: All pages and cover are intact (including the dust cover, if applicable). Spine may show signs of wear. Pages may include limited notes and highlighting. May include "From the library of" labels. Shrink wrap, dust covers, or boxed set case may be missing. Item may be missing bundled media.
- Used - Acceptable: All pages and the cover are intact, but shrink wrap, dust covers, or boxed set case may be missing. Pages may include limited notes, highlighting, or minor water damage but the text is readable. Item may but the dust cover may be missing. Pages may include limited notes and highlighting, but the text cannot be obscured or unreadable.
Note: Some electronic material access codes are valid only for one user. For this reason, used books, including books listed in the Used – Like New condition, may not come with functional electronic material access codes.
Shipping & Delivery
Shipping Fees
- Stevens Books offers FREE SHIPPING everywhere in the United States for ALL non-book orders, and $3.99 for each book.
- Packages are shipped from Monday to Friday.
- No additional fees and charges.
Delivery Times
The usual time for processing an order is 24 hours (1 business day), but may vary depending on the availability of products ordered. This period excludes delivery times, which depend on your geographic location.
Estimated delivery times:
- Standard Shipping: 5-8 business days
- Expedited Shipping: 3-5 business days
Shipping method varies depending on what is being shipped.
Tracking
All orders are shipped with a tracking number. Once your order has left our warehouse, a confirmation e-mail with a tracking number will be sent to you. You will be able to track your package at all times.
Damaged Parcel
If your package has been delivered in a PO Box, please note that we are not responsible for any damage that may result (consequences of extreme temperatures, theft, etc.).
If you have any questions regarding shipping or want to know about the status of an order, please contact us or email to support@stevensbooks.com.
Returns & Refunds
You may return most items within 30 days of delivery for a full refund.
To be eligible for a return, your item must be unused and in the same condition that you received it. It must also be in the original packaging.
Several types of goods are exempt from being returned. Perishable goods such as food, flowers, newspapers or magazines cannot be returned. We also do not accept products that are intimate or sanitary goods, hazardous materials, or flammable liquids or gases.
Additional non-returnable items:
- Gift cards
- Downloadable software products
- Some health and personal care items
To complete your return, we require a tracking number, which shows the items which you already returned to us.
There are certain situations where only partial refunds are granted (if applicable)
- Book with obvious signs of use
- CD, DVD, VHS tape, software, video game, cassette tape, or vinyl record that has been opened
- Any item not in its original condition, is damaged or missing parts for reasons not due to our error
- Any item that is returned more than 30 days after delivery
Items returned to us as a result of our error will receive a full refund,some returns may be subject to a restocking fee of 7% of the total item price, please contact a customer care team member to see if your return is subject. Returns that arrived on time and were as described are subject to a restocking fee.
Items returned to us that were not the result of our error, including items returned to us due to an invalid or incomplete address, will be refunded the original item price less our standard restocking fees.
If the item is returned to us for any of the following reasons, a 15% restocking fee will be applied to your refund total and you will be asked to pay for return shipping:
- Item(s) no longer needed or wanted.
- Item(s) returned to us due to an invalid or incomplete address.
- Item(s) returned to us that were not a result of our error.
You should expect to receive your refund within four weeks of giving your package to the return shipper, however, in many cases you will receive a refund more quickly. This time period includes the transit time for us to receive your return from the shipper (5 to 10 business days), the time it takes us to process your return once we receive it (3 to 5 business days), and the time it takes your bank to process our refund request (5 to 10 business days).
If you need to return an item, please Contact Us with your order number and details about the product you would like to return. We will respond quickly with instructions for how to return items from your order.
Shipping Cost
We'll pay the return shipping costs if the return is a result of our error (you received an incorrect or defective item, etc.). In other cases, you will be responsible for paying for your own shipping costs for returning your item. Shipping costs are non-refundable. If you receive a refund, the cost of return shipping will be deducted from your refund.
Depending on where you live, the time it may take for your exchanged product to reach you, may vary.
If you are shipping an item over $75, you should consider using a trackable shipping service or purchasing shipping insurance. We don’t guarantee that we will receive your returned item.
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