Geburtshilfe Frauenheilkd 2016; 76(10): 1081-1085
DOI: 10.1055/s-0042-112457
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Systematic Comparison of Different Meta-analyses, Systematic Reviews and HTA Reports on Cervical Cancer Screening based on Cytology or HPV Test

Systematischer Vergleich verschiedener Metaanalysen, systematischer Reviews und HTA-Berichte zum Zervixkarzinomscreening mittels Zytologie oder HPV-Test
M. Jentschke
Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
,
P. Hillemanns
Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
› Author Affiliations
Further Information

Publication History

received 19 April 2016
revised 17 June 2016

accepted 14 July 2016

Publication Date:
14 October 2016 (online)

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Abstract

Introduction: Cervical cancer screening programs all over the world are being radically revised; preventive screening is increasingly based on detecting infection with human papillomavirus (HPV). This change was driven by large international studies (comparing cytological and HPV-based screening), which were then summarized in systematic reviews or HTA reports. We carried out a systematic comparison of these meta-analyses, comparing their contents, quality, results and recommendations.

Material and Methods: A systematic search in MEDLINE identified eight meta-analyses. Seven more papers were also included in our analysis. The quality of these publications was reviewed using the AMSTAR criteria and presented in tabular form.

Results: There were significant differences with regard to the primary studies included in the meta-analyses, the quality of the meta-analyses, the endpoints, and the outcomes and recommendations based on these endpoints.

Conclusion: Different meta-analyses on the same or similar issues sometimes came to quite different conclusions because they used different approaches. This is quite significant because the underlying primary data did not change. The data indicated that HPV-based screening was superior. The heterogeneity of the meta-analyses affects the decisions taken by policymakers in the healthcare system.

Zusammenfassung

Einleitung: Das Zervixkarzinomscreening befindet sich weltweit im Umbruch und vollzieht einen Wandel hin zu einer Vorsorge, die auf dem Nachweis einer Infektion mit humanen Papillomviren (HPV) basiert. Dieser Wandel basiert auf großen internationalen Studien (Vergleich von Zytologie- und HPV-Screening), die in der Regel in systematischen Übersichtsarbeiten oder HTA-Berichten zusammengefasst werden. Diese Arbeit stellt einen systematischen Vergleich dieser Metaanalysen dar im Hinblick auf Inhalt, Qualität, Ergebnisse und Empfehlungen.

Material und Methoden: Durch eine systematische Suche in MEDLINE konnten 8 Metaanalysen identifiziert werden. Sieben weitere Arbeiten wurden in die Analyse eingeschlossen. Die Qualität wurde mittels AMSTAR überprüft und tabellarisch dargestellt.

Ergebnisse: Es zeigten sich teilweise deutliche Unterschiede im Hinblick auf die eingeschlossenen Primärstudien, die Qualität der Metaanalysen, die Endpunkte und auch die Ergebnisse und die daraus resultierenden Empfehlungen.

Schlussfolgerung: Unterschiedliche Metaanalysen zu gleichen oder ähnlichen Fragestellungen liefern aufgrund unterschiedlicher Ansätze teilweise auch deutlich unterschiedliche Ergebnisse. Dies ist beachtlich, da sich die zugrunde liegenden primären Daten nicht ändern. Diese sprechen für eine Überlegenheit des HPV-basierten Screenings. Die Entscheidungsträger im Gesundheitssystem werden so durch die heterogene Durchführung der Metaanalysen in ihren Entscheidungen beeinflusst.

Key words

cervical cancer screening - HPV - cytology - dysplasia

Schlüsselwörter

Zervixkarzinomscreening - HPV - Zytologie - Dysplasie

Supporting Information

 

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