The role of Pap test screening against cervical cancer: a systematic review and meta-analysis.
OBJECTIVE
The first aim of this article is to quantify the role of Pap test in cervical cancer prevention, updating the pool of available studies included in a previous meta-analysis. Potential sources of meta-analysis heterogeneity were investigated as second aim. Further evidence of cost-effectiveness has been provided about age and best time interval to perform Pap test screening.


METHODS
The articles' search was conducted using four medical electronic databases: PubMed, Google Scholar, ISI Web, and Scopus. Papers published until the 30th November 2013 were included. The research on Google Scholar was limited to the first 10 pages of web for each study design.
A systematic review/meta-analysis was performed according to PRISMA Statement. New-Castle-Ottawa Scale and Jadad have been adopted for articles quality assessment. From 4143 screened articles, 34 met eligibility criteria and 30 case-control studies were included in meta-analysis. Meta-analysis was carried out using StatsDirect2.8.0. Heterogeneity was investigated with qualitative and quantitative approaches in sensitivity-analysis.


RESULTS
Despite a great heterogeneity (Cochran Q=504.466, df=29, p<0.0001; I²=94.3%; 95%CI=93.1%-95.1%), a significant protective effect of Pap test has been identified (OR=0.33; 95%CI=0.268-0.408, P <0.00011) through the meta-analysis. Sensitivity analysis did not provide significant results (R=0.358 R2=0.128 p<0.469).


CONCLUSIONS
The protective role of Pap test against cervical cancer has been confirmed especially among women <40 years. Annual screening still remains the most cost-effective preventive strategy.
Department of Public Health and Infectious Diseases Sapienza University of Rome.
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A
Meggiolaro
Department of Public Health and Infectious Diseases Sapienza University of Rome.
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B
Unim
Department of Public Health and Infectious Diseases Sapienza University of Rome.
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L
Semyonov
Department of Public Health and Infectious Diseases Sapienza University of Rome.
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S
Miccoli
Department of Public Health and Infectious Diseases Sapienza University of Rome.
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E
Maffongelli
Department of Public Health and Infectious Diseases Sapienza University of Rome.
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G
La Torre
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics
Cervical cancer; Meta-analysis; Metaregression; Pap test; Screening