The DOI matches its Crossref record; 130 of the 130 references it cites were found in a registry or an index; 14 of the 33 sources its claims cite were checked for support.
Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses
Open accessAbstract
Objective: To evaluate the diagnostic accuracy of high-risk human papillomavirus (hrHPV) assays on self samples and the efficacy of self sampling strategies to reach underscreened women. Design: Updated meta-analysis. Data sources: Medline (PubMed), Embase, and CENTRAL from 1 January 2013 to 15 April 2018 (accuracy review), and 1 January 2014 to 15 April 2018 (participation review). Review methods: Accuracy review: hrHPV assay on a vaginal self sample and a clinician sample; and verification of the presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) by colposcopy and biopsy in all enrolled women or in women with positive tests. Participation review: study population included women who were irregularly or never screened; women in the self sampling arm (intervention arm) were invited to collect a self sample for hrHPV testing; women in the control arm were invited or reminded to undergo a screening test on a clinician sample; participation in both arms was documented; and a population minimum of 400 women. Results: 56 accuracy studies and 25 participation trials were included. hrHPV assays based on polymerase chain reaction were as sensitive on self samples as on clinician samples to detect CIN2+ or CIN3+ (pooled ratio 0.99, 95% confidence interval 0.97 to 1.02). However, hrHPV assays based on signal amplification were less sensitive on self samples (pooled ratio 0.85, 95% confidence interval 0.80 to 0.89). The specificity to exclude CIN2+ was 2% or 4% lower on self samples than on clinician samples, for hrHPV assays based on polymerase chain reaction or signal amplification, respectively. Mailing self sample kits to the woman’s home address generated higher response rates to have a sample taken by a clinician than invitation or reminder letters (pooled relative participation in intention-to-treat-analysis of 2.33, 95% confidence interval 1.86 to 2.91). Opt-in strategies where women had to request a self sampling kit were generally not more effective than invitation letters (relative participation of 1.22, 95% confidence interval 0.93 to 1.61). Direct offer of self sampling devices to women in communities that were underscreened generated high participation rates (>75%). Substantial interstudy heterogeneity was noted (I 2 >95%). Conclusions: When used with hrHPV assays based on polymerase chain reaction, testing on self samples was similarly accurate as on clinician samples. Offering self sampling kits generally is more effective in reaching underscreened women than sending invitations. However, since response rates are highly variable among settings, pilots should be set up before regional or national roll out of self sampling strategies.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
In updated meta-analyses of 56 diagnostic accuracy studies and 25 randomized participation trials, hrHPV testing on self samples was as sensitive as clinician samples when using PCR-based assays, but less sensitive with signal-amplification assays. Mailing self-sampling kits increased participation among underscreened women, though effects varied substantially by invitation strategy and setting.
Key findings
- PCR-based hrHPV assays on self samples were as sensitive as clinician samples for CIN2+ (pooled ratio 0.99, 95% CI 0.97 to 1.02) and CIN3+ (0.99, 0.96 to 1.02), with slightly lower specificity to exclude CIN2+ (0.98, 0.97 to 0.99).
- Signal-amplification hrHPV assays were less sensitive on self samples for CIN2+ (0.85, 0.80 to 0.89) and CIN3+ (0.86, 0.76 to 0.98), and less specific to exclude CIN2+ (0.96, 0.93 to 0.98).
- In intention-to-treat analysis, mailing self-sampling kits to the home increased participation versus invitation/reminder letters (relative participation 2.33, 95% CI 1.86 to 2.91), whereas opt-in strategies were not significantly more effective (1.22, 0.93 to 1.61).
- Door-to-door delivery generated high participation (>75%; pooled self-sampling participation 94.2% per protocol and 94.6% intention-to-treat), and CIN2+ detection per 1000 invited women was higher in self-sampling arms (relative proportion 2.28, 95% CI 1.44 to 3.61).
Methods
- Updated meta-analyses: accuracy review searched Medline, Embase, and CENTRAL from 1 January 2013 to 15 April 2018; participation review searched from 1 January 2014 to 15 April 2018.
- Included 56 diagnostic test accuracy studies comparing hrHPV testing on vaginal self samples versus clinician samples with CIN2+/CIN3+ verification, and 25 randomized trials of self-sampling offers among irregularly/never-screened women with at least 400 women.
- Pooled accuracy using a bivariate normal model for logit-transformed sensitivity/specificity; pooled participation using random-effects models for proportions and ratios; assessed quality with QUADAS-2 and Cochrane risk-of-bias tools.
Limitations
- Stated: meta-analyses based on aggregated published results lacked detailed data equally stratified by potentially influencing factors; meta-regression including only eight studies did not reveal age effects, and subgroup analyses/meta-regressions were not possible because covariates were categorized differently across studies.
- Stated: the authors propose pooling individual patient data from the best trials to evaluate influential factors more efficiently.
- Evident: substantial interstudy heterogeneity was noted (I²>95%), including high heterogeneity for participation outcomes and opt-in results (P<0.001), and quality reporting was incomplete for some domains, such as uninterpretable results poorly reported for evaluated tests (39%) and reference standard (45%).
Model-written summary. Check it against the paper before relying on it.
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Verification
Claims the paper makes
14 of 33 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The participation was not significantly different when hrHPV testing was performed versus when cytology was performed (P=0.60 v P=0.76).104 117”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Efficacy of invitation scenarios
What the sources say
- Partly supportedcites [104] sourceExperimental — accuracy not yet measured
The Results (‘Effect on compliance’; page unavailable) report similar participation after invitations for clinic-based HPV testing (14.9%) and standard Pap-test recall (13.9%). The Abstract (‘Results’; page unavailable) explicitly calls the difference nonsignificant. Our copy does not report the cited P=0.60 or P=0.76 values; this paper also accounts for only one of the two studies cited. (LLM, conf=0.83)
- Partly supportedcites [117] sourceExperimental — accuracy not yet measured
The Results (page unavailable) report no difference in participation between the cytology and HPV clinic-control groups at one centre. However, the reported P value is 0.9, not 0.60 or 0.76; this source does not support the quoted figures or the claim about two studies. (LLM, conf=0.88)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Third, a proportion of screened women with cervical precancer and cancer show false negative Pap tests.18 19”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Introduction
What the sources say
- Not checked — no full text of the sourcecites [18] source
- Supportedcites [19] Koliopoulos, 2017, Cytology versus HPV testing for cervical cancer screening in the general population, Cochrane Database Syst Rev source
The Rationale section reports that some women who developed cervical cancer had previously had false-negative Pap smears. The Quality of the evidence section also reports false-negative Pap results for CIN 2+ (cervical precancer). (LLM, conf=0.94)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In the first control arm (reminder letter) the response rate was 10.5% (95% confidence interval 9.9% to 11.2%)”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Efficacy of invitation scenarios
What the sources say
- Partly supportedcites [69] sourceExperimental — accuracy not yet measured
The Participation section reports that 931 of 8,830 women (10.5%) in the recall-letter control group had a Pap smear within 12 months. Our copy does not report the claimed 95% confidence interval of 9.9% to 11.2%, although it is consistent with the reported counts. (LLM, conf=0.82)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Three (12%) of the 25 trials met the criteria for low risk of bias in all categories.114 115 117”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Quality of randomized clinical trials in the participation review
What the sources say
- Partly supportedcites [114] sourceExperimental — accuracy not yet measured
The Design (p. 2) identifies this source as a randomized trial, and Randomization and blinding (p. 4) describes its allocation and blinding procedures. The paper does not assess 25 trials or establish that three met low-risk-of-bias criteria in every category; it supports identifying one trial, not the aggregate claim. (LLM, conf=0.82)
- Could not verifycites [115] sourceExperimental — accuracy not yet measured
The Materials and Methods > Design section describes this paper as a single three-group randomised trial, not an assessment of 25 trials. Searches for “25 trials” and “low risk of bias” found no passage in our copy reporting that three trials (12%) met low-risk criteria in all categories. Page numbers were not available in the indexed passages. (LLM, conf=0.77)
- Could not verifycites [117] sourceExperimental — accuracy not yet measured
The Methods (Analysis and Study design; page unavailable) describe this paper’s own randomized trial, not an assessment of 25 trials. Searches for “25 trials,” “low risk of bias,” and “three trials 12%” found no passage reporting the claimed count or bias rating. (LLM, conf=0.75)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“whereas in the second control arm (no letter), the response rate was slightly lower (8.0%, 95% confidence interval 7.5% to 8.6%)”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Efficacy of invitation scenarios
What the sources say
- Partly supportedcites [69] sourceExperimental — accuracy not yet measured
The Participation section reports that 709 women (8%) in the no-intervention arm had a PAP smear within 12 months, and the study description identifies this as the second control group. Our copy does not report the claimed 95% confidence interval of 7.5%–8.6% for that rate; the Statistical analysis section discusses confidence intervals for odds ratios instead. Page numbers are not available for these passages. (LLM, conf=0.86)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Second, certain groups of the target population do not attend screening.15 16 17”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Introduction
What the sources say
- Not checked — no full text of the sourcecites [15] source
- Not checked — no full text of the sourcecites [16] source
- Supportedcites [17] source
The Results (Social status) report screening coverage of 40% among women receiving increased health-care reimbursement, compared with 64% among other women in the Belgian target population. The Results (Age groups) also show lower coverage in older target-age groups. These findings support the claim that some groups do not attend screening. (LLM, conf=0.93)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Two previous participation meta-analyses showed that sending self sampling kits to a woman’s home address generated greater response rates than invitation or reminder letters.23 24”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Introduction
What the sources say
- Not checked — no full text of the sourcecites [23] source
- Partly supportedcites [24] Racey, 2013, Self-collected HPV Testing Improves Participation in Cervical Cancer Screening: A Systematic Review and Meta-analysis, Can.J.Public Health sourceExperimental — accuracy not yet measured
The Synthesis in our copy (Abstract; page not specified) reports that this meta-analysis found greater screening participation with self-collected HPV testing than with Pap testing. It does not establish the more specific comparison of kits sent to home addresses against invitation or reminder letters, so that part of the claim is unsupported by the available passages. (LLM, conf=0.76)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesEvery source the paper cites for this claim was checked and supports it.
In the paper
“We found five studies that provided response rates in both trial arms stratified by categories defined on the screening history status.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Efficacy of invitation scenarios
What the sources say
- Supportedcites [26] source
The Results section (‘Participation in relation to screening history’; page not available) reports participation comparisons between intervention and control groups for women with different screening histories. The Methods section (‘Statistical analysis’; page not available) also states that participation analyses were stratified by screening history. This paper therefore fits as one of the studies the citing authors identified; the count of five is the citing authors’ own finding. (LLM, conf=0.90)
- Supportedcites [65] source
The Participation (as randomised) section reports participation rates for both trial arms separately for apparently never-screened and under-screened women. This confirms that the cited trial is one study with rates stratified by screening history; the citing authors’ count of five studies is their own finding, not a finding attributed to this paper. (LLM, conf=0.91)
- Supportedcites [103] source
The Results (Participation rate; page unavailable) report response rates in both the self-sampling and recall-control arms, separately for women who had and had not had a smear in the past seven years. This confirms that the cited paper is one study fitting the citing authors’ description; the count of five studies is the citing authors’ own finding. (LLM, conf=0.92)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, in screening studies, where partial verification bias was avoided, the specificity of the hrHPV assay based on signal amplification on self samples was significantly lower (83%) than in studies where verification was not avoided or unclear (87%; P=0.03).”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Accuracy of hrHPV assay
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Direct offer of self sampling devices to women in communities that were underscreened generated high participation rates (>75%).”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- Probably not a substantial claim. 9
- It may state two separate claims as one. 19
- The quote only partly states this claim. 2
Every source the paper cites for this claim was checked and supports it.
In the paper
“We assessed the quality of the randomized clinical trials for the participation review by using the Cochrane Collaboration’s tool for risk of bias in randomized trials.30”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Methods > Study selection, data extraction, and checking
What the sources say
- Supportedcites [30] source
The Additional information section identifies this as the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. The citation identifies the instrument the citing authors say they used; their use of it in the participation review is not a finding attributed to this source. (LLM, conf=0.93)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Each hrHPV assay based on polymerase chain reaction was equally sensitive for CIN2+ and for CIN3+ on self samples versus clinician samples.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Accuracy of hrHPV assay
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“56 accuracy studies and 25 participation trials were included.”
- Also stated in: § Results · plain
“The updated meta-analyses finally comprised 56 diagnostic test accuracy studies and 25 randomized trials.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Abstract > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In general, hrHPV assays were less specific on self samples except for the HC2 assay on a tampon self sample (n=1) or an assay based on polymerase chain reaction on a vaginal lavage self sample (2).”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Accuracy of hrHPV assay
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The test positivity rate was, on average, 14% higher and the positive predictive value was significantly lower for both CIN2+ and CIN3+ for self samples (positive predictive value< 1).”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Accuracy of hrHPV assay
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The test positivity rate was similar in self samples versus clinician samples.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Accuracy of hrHPV assay
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The participation difference was nearly always positive except for two studies where the difference was significantly lower than zero.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Efficacy of invitation scenarios
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“whereas on average in the intention-to-treat analysis, the pooled relative participation exceeded unity, although not significantly (1.22, 0.93 to 1.61)”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Efficacy of invitation scenarios
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The quality of verification with a reference standard (acceptable validity, blinding toward tests, and avoidance of incorporating test results in final conclusion of disease outcome) was good in 84%, moderate in 13%, and problematic in 4% of the studies.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Quality of diagnostic studies in the accuracy review
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Reporting and execution of tests (description of cut-off, blinding of the index test toward comparator and reference test) was adequate in 73% and unclear in 27%, but the risk of bias was never assessed as high.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Quality of diagnostic studies in the accuracy review
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The risk of bias for enrolment of women was considered low in 59%, moderate in 39%, and high in 2% of the 56 diagnostic studies (supplementary materials).”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Quality of diagnostic studies in the accuracy review
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Withdrawal of patients was explained appropriately in 70%, but not in 18%, and unclear in 12% of the studies.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Quality of diagnostic studies in the accuracy review
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“We assessed the quality of the diagnostic studies for the accuracy review by using the QUADAS-2 check list.29”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Methods > Study selection, data extraction, and checking
What the sources say
- Not checked — no full text of the sourcecites [29] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The delay between self sampling, clinician sampling, and verification with the reference standard was short in 61%, unreported in 38%, and long in 2% of the studies.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Quality of diagnostic studies in the accuracy review
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The meta-analyses followed PRISMA guidelines for reporting of meta-analyses, and recommendations established by the Cochrane Collaboration for diagnostic test accuracy and intervention trials.31 32”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Methods > Statistical methods
What the sources say
- Not checked — no full text of the sourcecites [31] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, Ann Intern Med source
- Not matchedcites [32] Deeks, 2013
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All trials had complete data for the participation outcome and were therefore at low risk of attrition bias.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Quality of randomized clinical trials in the participation review
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“However, recent trend analyses reveal an increasing burden of cervical cancer, even in countries with well organized screening programs based on cytology and good coverage.8 9 10 11 12”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Introduction
What the sources say
- Not checked — no full text of the sourcecites [8] source
- Not checked — no full text of the sourcecites [9] source
- Not matchedcites [10] Finnish Cancer Registry. Cancer Statistics. Cancer Society of Finland. https://cancerregistry.fi/statistics/cancer-statistics/
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“We assessed publication bias by using Deeks' and Harbord's regression tests for the pooled absolute and relative accuracy estimates, respectively.36 37”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Methods > Statistical methods
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The previous accuracy meta-analysis concluded that hrHPV testing was less sensitive on self samples than on clinician samples, but also found that the reason for lower sensitivity was the use of assays based on signal amplification.22”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Introduction
What the sources say
- Not checked — no full text of the sourcecites [22] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Partial verification was avoided in 70% but clearly present in 25%, whereas differential verification was absent in 89% but unclear or present in 11% of the studies.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Quality of diagnostic studies in the accuracy review
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“hrHPV testing provides another advantage: it can be done on vaginal samples collected by the patient (self samples), whereas cytology on self samples shows poor accuracy.21”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Introduction
What the sources say
- Not checked — no full text of the sourcecites [21] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“MA and one other author (SBS, ST, FS, or a Collaboration on Self-Sampling and HPV Testing group member) independently performed the study selection and data extraction. PC judged any unresolvable discordances.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Methods > Study selection, data extraction, and checking
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Most cervical cancer cases occur in women who have never been screened for cervical cancer, or do not participate in routine screening.7”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Introduction
What the sources say
- Not matchedcites [7] IARC, 2005
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The quality of reporting was adequate in 12 trials (48%),26 67 102 103 104 107 108 109 114 115 116 117 118 incomplete in one trial,106 and intermediate in the other trials.”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Quality of randomized clinical trials in the participation review
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In eight trials (32%) allocation was random and concealed,26 63 64 65 104 114 115 117 in 14 trials (56%) allocation was unclear,66 67 102 103 105 106 107 108 109 110 111 112 113 116 and in three trials (12%) allocation was problematic.62 68 69”
§ Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses > Results > Quality of randomized clinical trials in the participation review
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
Intention-to-treat analyses of participation trials reflect the overall public health effect in a real world situation.
“In the intention-to-treat analyses, which reflected the overall public health effect in a real world situation, we additionally included women in the experimental arm who had been offered self sampling but choose to have a clinician sample taken instead.”
The paper relies on this without support.
New assays, self sampling devices, storage media, and participation strategies have entered the market since the publication of the two previous meta-analyses, and more accuracy and participation studies have been conducted.
“New assays, self sampling devices, storage media, and participation strategies have entered the market since the publication of these two meta-analyses; and more accuracy and participation studies have been conducted.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Encouragingly, there is promising evidence supporting the potential of a self-sampling approach to increase screening participation in under-screened and never-screened women and the efficacy of a single-dose vaccine to facilitate straightforward implementation of the programs.[144][145][146]”
From Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. (2024) · cites this paper as [145]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“as shown by multiple previous studies, the Roche Cobas 4800 assay is known for having a relatively high sensitivity compared with other HPV assays (12, 13, 17).”
From Comparison between the Roche Cobas 4800 Human Papillomavirus (HPV), Abbott RealTime High-Risk HPV, Seegene Anyplex II HPV28, and Novel Seegene Allplex HPV28 Assays for High-Risk HPV Detection and Genotyping in Mocked Self-Samples (2023) · cites this paper as [12]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“An additional and significant benefit of HPV-based screening is that vaginal samples collected via self-collection, hereafter referred to as self-collection, can detect HPV at levels indicative of precancer of the cervix (cervical intraepithelial neoplasia grade 2 or above—CIN2+) as accurately as cervical samples collected using a speculum by a clinician.8”
From Protocol for a cervical screening implementation trial comparing two approaches for delivering HPV self-collection in low-resource settings in India: a type 3 hybrid cluster randomised controlled trial (SHE-CAN) (2025) · cites this paper as [8]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Polymerase chain reaction (PCR) based HPV assays to detect high-risk HPVs are as accurate on HPV self-samples as the clinician collected samples [8].”
From Performance of HPV Self-Sample Collected by a Novel Kit in Comparison with Clinician Collected Sample for Cervical Cancer Screening (2024) · cites this paper as [8]
The cited source says what the claim attributes to it.
In the citing paper
“This has led to improved screening rates among unscreened women.8 9 16 18 48”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Vaginal-lavage study count differs between text and table
MinorThe text gives a count of two for polymerase-chain-reaction testing on vaginal lavage self samples, but table 2 lists four studies for that category.
“an assay based on polymerase chain reaction on a vaginal lavage self sample (2)”
“| Lavage† | 4 | 0.95 (0.87 to 1.04) | 1.09 (0.91 to 1.30) |”
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Flagged first, then by citations
Research works printed but not linked: 2
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- Deeks, 2013, Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0.0.
Cited by
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“38,39 Surveillance system and health infrastructures, developed to monitor the COVID-19 pandemic could be customised to improve HPV vaccination, the monitoring of national cervical cancer screening programmes, and to improve health system capacity to deliver more efficient preventive services.”
Self-citationEstimates of the global burden of cervical cancer associated with HIV
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Metadata
- Authors
- Arbyn, M., Smith, S. B., Temin, S., Sultana, F., & Castle, P.
- Affiliations
- Sciensano (Belgium) (BE)
- American Society of Clinical Oncology (US)
- The University of Melbourne (AU)
- Albert Einstein College of Medicine (US)
- Corresponding author
- Arbyn, Marc
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2018-12-05
- Volume
- 363
- Pages
- k4823
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC6278587
- OpenAlex
- W2902810541
- Semantic Scholar
- 19a6b46f3981556042ef796240496a98ab9d26f6
- Cited by
- 851
- References
- 130
- Citations by year
- 2026: 93 · 2025: 136 · 2024: 136 · 2023: 137 · 2022: 116 · 2021: 104 · 2020: 89 · 2019: 39
- FWCI
- 39.55
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (submittedVersion, other-oa)
- PubMed Central (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Keywords
- cervical cancer screening, HPV testing, self-sampling, cervical intraepithelial neoplasia, CIN2+ detection, diagnostic accuracy, underscreened women, screening uptake, reminder letters, clinician-collected samples, community-based screening
- MeSH terms
- Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Colposcopy, Female, Humans, Mass Screening, Sensitivity and Specificity, Specimen Handling, Vagina, Vaginal Smears, Incidence, Randomized Controlled Trials as Topic, Papillomaviridae, Papillomavirus Infections, Early Detection of Cancer, Intention to Treat Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-16, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-16 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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