Cervical cancer.
BACKGROUND
Worldwide, cervical cancer is the second most common cancer in women. The peak prevalence of infection is 20-30% in women aged 20-30 years, but in 80% of cases the infection resolves within 12-18 months. In the UK, incidence fell after introduction of the cervical-screening programme, to the current level of approximately 3200 cases and 1000 deaths a year. Survival ranges from almost 100% 5-year disease-free survival for treated stage Ia disease to 5-15% in stage IV disease. Survival is also influenced by tumour bulk, age, and comorbid conditions.


METHODS
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to manage early-stage cervical cancer? What are the effects of interventions to manage bulky early-stage cervical cancer? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).


RESULTS
We found 18 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.


CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: HPV vaccine for preventing cervical cancer and conisation of the cervix for microinvasive carcinoma (stage Ia1), neoadjuvant chemotherapy, radiotherapy, chemoradiotherapy, or different types of surgery for treating early stage and bulky early stage cervical cancer.
Sundar
Sudha
S
Pan Birmingham Gynaecological Cancer Centre, City Hospital and Division of Cancer Studies, University of Birmingham, Birmingham, United Kingdom.
Horne
Amanda
A
Kehoe
Sean
S
D059248:Chemoradiotherapy; D019092:Conization; D018572:Disease-Free Survival; D006801:Humans; D020360:Neoadjuvant Therapy; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms