Impact of hysterectomy correction on estimated cervical cancer screening rates and cervical cancer incidence rates: A systematic review

Abstract Aim This systematic review aimed to synthesize evidence on how correcting for hysterectomy affects estimates of cervical cancer screening participation rates (CCSPR) and cervical cancer incidence rates (CCIR). Subject and methods We searched four electronic databases and gray literature sources. Two reviewers independently screened titles, abstracts, and full texts. Data were extracted using a standardized tool, and study quality was assessed using the Joanna Briggs Institute (JBI) checklist. Results were synthesized by study outcomes, hysterectomy data sources, and country, with additional comparisons by socio-demographic factors. Results Twenty-one studies met the inclusion criteria. Upon correction for hysterectomy, the relative increase in CCSPR ranged from 1% to 19% and in CCIR from 5% to 59% compared to uncorrected estimates. The increase in CCSPR was greater among women aged > 50 years, while CCIR increases were more pronounced in those > 60 years, resulting in comparable rates across older age groups after correction. Correction also shifted the age of peak CCSPR and CCIR, reflecting hysterectomy prevalence patterns. Available evidence from a few studies suggests higher corrected CCIR among ethnic minorities and women of lower socioeconomic status. Conclusion Adjusting hysterectomy prevalence is essential to avoid biased estimates of CCSPR and CCIR. Future studies need to consider reporting hysterectomy-corrected estimates disaggregated by sociodemographic characteristics.