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CADTH » Search All Products » Environmental Scanning » Health Technology Update » Issue 11- August 2009 » Liquid-Based Techniques for Cervical...

Liquid-Based Techniques for Cervical Cancer Screening

The evolution of cervical cell collection techniques for the detection of cervical precursor lesions has opened up new possibilities for alternative cervical screening strategies.

The new technologies, liquid-based cytology (LBC) and tests for the presence of human papillomavirus or HPV, are intended to improve the detection of cervical precursor lesions and provide a platform for human papillomavirus testing. Until recently, the only option for cervical cancer screening was conventional cytology (CC) with an annual Pap smear.

In an effort to determine the health and economic implications of these newer technologies in comparison to CC, CADTH has published two comprehensive assessments on this topic: in November 2003 and, most recently, in February 2008. The latest assessment examined the diagnostic and cost-effectiveness of strategies based on these technologies compared with CC conducted annually. The report cites the following implications for decision-making:

  • LBC and CC perform similarly. The clinical evidence suggests that LBC is similar to CC regarding sensitivity and specificity. LBC is probably more sensitive and less specific, and may have a lower rate of unsatisfactory specimens.
  • LBC strategies can be cost-effective, but they increase colposcopy referrals. Model projections suggest that LBC with HPV triage every two years can be cost-saving compared to an annual screening strategy with CC alone.
  • HPV triage is cost-effective. Direct comparison of all screening and triage strategies indicate that annual screening with CC or LBC is always more costly and less effective than when paired with HPV triage. Adding HPV triage to annual CC can reduce colposcopy referrals by 5%. Compared to annual CC with HPV triage, LBC with HPV every two years will reduce disease burden further by 0.0004 QALYs, while increasing costs ($52 per person, discounted) and colposcopy referrals by 72%.

The findings of this report have been considered by provincial and territorial health ministries. Indeed, the Public Health Agency of Canada requested a presentation of the report findings to the Cervical Cancer Prevention and Control Network Steering Committee in May of 2009. CADTH has received positive feedback from decision-makers on the impact of this report.

CADTH’s 2003 assessment on this topic was considered by key health professional groups and Health Canada at a workshop entitled “Building on Success: A Pan-Canadian Forum on Cervical Screening” in Ottawa in November of 2003. The CADTH findings from this report formed the basis of published evidence-based recommendations on the delivery of cervical cancer screening within the Canadian health system.

Liquid-based techniques for cervical cancer screening: Systematic review and cost-effectiveness analysis.

CADTH, 2008: http://www.cadth.ca/index.php/en/hta/reports-publications/search/publication/799.

Liquid-based cytology and human papillomavirus testing in cervical cancer screening. CCOHTA, 2003: http://www.cadth.ca/index.php/en/media-centre/?&news_id=29.

Report of the 2003 Pan-Canadian forum on cervical cancer prevention and control.  J Obstet Gynaecol Can, 2004: http://cap-acp.org/cmsUploads/CAP/File/report_pan_canadian_forum.pdf.