Cervical Cancer Screening

IARC Handbooks of Cancer Prevention Volume 18







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A Working Group of 27 independent international experts, convened by the International Agency for Research on Cancer (IARC) between June and October 2020, reviewed the scientific evidence and assessed the cancer-preventive and adverse effects of various methods of screening for cervical cancer. Cervical cancer is the fourth most commonly diagnosed cancer type in women worldwide, and the fourth most common cause of cancer death in women.

This publication is an important update of the previous IARC Handbook on cervical cancer screening (Volume 10, published in 2005). Volume 18 provides evidence-based evaluations of the effectiveness of five methods of cervical cancer screening in reducing cervical cancer incidence and/or mortality. The Working Group also reviewed the body of evidence and provided conclusive statements on the comparative effectiveness of those screening methods that are established to reduce cervical cancer incidence and/or mortality. In addition, the Working Group provided an updated literature review on the determinants of participation in screening programmes and on emerging techniques, as well as on the different categories of women at differential risk and the surveillance strategies for such women.

Cover pages


Note to the Reader

List of Participants


General Remarks

List of Abbreviations


1. Cervical Cancer

2. Cervical Cancer Screening Programmes

3. Participation in Screening for Cervical Cancer

4. Preventive and Adverse Effects of Cervical Cancer Screening

4.1 Methodological issues

4.2 Screening by visual inspection

4.3 Cytological methods

4.4 HPV testing

4.5 Colposcopy

4.6 Emerging technologies

5. Screen-and-Treat Approach and Women at Differential Risk

6. Summary

7. Evaluations and Comparison Statements

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Web-only tables

Table 4.13 Case–control studies on the effectiveness of cervical cancer screening within service screening programmes using conventional cytology

Table 4.36 Meta-analysis and reviews to evaluate the accuracy of colposcopy as a diagnostic method

Table 4.37 Risk of cervical precancer based on the results of screening and follow-up tests

Annex 1. Supplementary material for Section 4.4.7 Triage of women with a positive primary HPV screening test result

Box S1 PICOS components of the research question

Fig. S1 PRISMA flow diagram showing the retrieval and selection of studies

Fig. S2 Summary of the assessment of study quality of reports included in the meta-analysis of the accuracy of triage tests used to manage hrHPV-positive women

Fig. S3 Meta-analysis of the absolute sensitivity and specificity of triage of HPV-positive women with reflex cytology at a threshold of ASC-US+ to detect CIN2+

Fig. S4 Meta-analyses of the accuracy for detection of CIN2+ of six tests or combinations of tests used to triage hrHPV-positive women

Fig. S5 Meta-analyses of the accuracy for detection of CIN3+ of four tests or combinations of tests used to triage hrHPV-positive women

Table S1 Number of true-positive, false-positive, false-negative, and true-negative results in 1000 women with a positive hrHPV test result at screening and triaged with one of six selected scenarios; PPV, NNR (= 1/PPV), NPV, and cNPV estimated for three situations of underlying background risk of CIN3+: low risk, 5%; intermediate risk, 8%; high risk, 17%