Evidence map›Paper›PMID 28606721›Full record

ArticleGynecologic oncology2017

Why does cervical cancer occur in a state-of-the-art screening program?

Philip E Castle, Walter K Kinney, Li C Cheung, Julia C Gage, Barbara Fetterman, Nancy E Poitras, Thomas S Lorey, Nicolas Wentzensen, Brian Befano, John Schussler and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Gynecologic oncology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 1 synthesis or guideline pooled it.

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  16. Letter to the Editor: Persisting Health Disparities in Women Living with HIV from the US.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Philip E CastleAlbert Einstein College of Medicine, Bronx, NY, USA. Electronic address: philip.castle@einstein.yu.edu.
Walter K KinneyRegional Laboratory, The Permanente Medical Group, Oakland, CA, USA.
Li C CheungDivision of Cancer Epidemiology and Genetics, NCI, Bethesda, MD, USA.
Julia C GageDivision of Cancer Epidemiology and Genetics, NCI, Bethesda, MD, USA.
Barbara FettermanRegional Laboratory, The Permanente Medical Group, Oakland, CA, USA.
Nancy E PoitrasRegional Laboratory, The Permanente Medical Group, Oakland, CA, USA.
Thomas S LoreyRegional Laboratory, The Permanente Medical Group, Oakland, CA, USA.
Nicolas WentzensenDivision of Cancer Epidemiology and Genetics, NCI, Bethesda, MD, USA.
Brian BefanoIMS, Calverton, MD, USA.
John SchusslerIMS, Calverton, MD, USA.
Hormuzd A KatkiDivision of Cancer Epidemiology and Genetics, NCI, Bethesda, MD, USA.
Mark SchiffmanDivision of Cancer Epidemiology and Genetics, NCI, Bethesda, MD, USA.

Funding

Intramural NIH HHS Z99 CA999999
6 · The paper itself

Abstract

backgroundThe goal of cervical screening is to detect and treat precancers before some become cancer. We wanted to understand why, despite state-of-the-art methods, cervical cancers occured in relationship to programmatic performance at Kaiser Permanente Northern California (KPNC), where >1,000,000 women aged ≥30years have undergone cervical cancer screening by triennial HPV and cytology cotesting since 2003.

methodsWe reviewed clinical histories preceding cervical cancer diagnoses to assign "causes" of cancer. We calculated surrogate measures of programmatic effectiveness (precancers/(precancers and cancers)) and diagnostic yield (precancers and cancers per 1000 cotests), overall and by age at cotest (30-39, 40-49, and ≥50years).

resultsCancer was rare and found mainly in a localized (treatable) stage. Of 623 cervical cancers with at least one preceding or concurrent cotest, 360 (57.8%) were judged to be prevalent (diagnosed at a localized stage within one year or regional/distant stage within two years of the first cotest). Non-compliance with recommended screening and management preceded 9.0% of all cancers. False-negative cotests/sampling errors (HPV and cytology negative), false-negative histologic diagnoses, and treatment failures preceded 11.2%, 9.0%, and 4.3%, respectively, of all cancers. There was significant heterogeneity in the causes of cancer by histologic category (p<0.001 for all; p=0.002 excluding prevalent cases). Programmatic effectiveness (95.3%) and diagnostic yield were greater for squamous cell versus adenocarcinoma histology (p<0.0001) and both decreased with older ages (p

conclusionsA state-of-the-art intensive screening program results in very few cervical cancers, most of which are detected early by screening. Screening may become less efficient at older ages.

Indexed as

Early Detection of CancerAdenocarcinomaAdultAge FactorsCarcinoma, Squamous CellCytodiagnosisFalse Negative ReactionsFemaleHumansMiddle AgedPapillomaviridaePatient CompliancePrecancerous ConditionsTreatment FailureUterine Cervical DysplasiaUterine Cervical NeoplasmsCervical cancerCIN3CotestingCytologyHuman papillomavirus (HPV)Precancer

Identifiers

PMID28606721
PMCPMC5743197

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.