{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:21:30Z","timestamp":1789802490321,"version":"4.0.1"},"reference-count":62,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical cancer elimination efforts increasingly rely on human papillomavirus (HPV)\u2013based screening. However, the optimal approach to screening beyond age 65\u2009years and the role of self\u2010sampling in older women remain uncertain in the HPV era.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate HPV\u2010based cervical cancer screening strategies, including self\u2010sampling, in women aged 65\u2009years and older and to quantify outcomes relevant to extended\u2010age or \u201ccatch\u2010up\u201d approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Search Strategy<\/jats:title>\n                    <jats:p>We searched major bibliographic databases for studies assessing HPV\u2010based screening and self\u2010sampling in women 65\u2009years and older in the HPV era.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Selection Criteria<\/jats:title>\n                    <jats:p>We included studies evaluating HPV\u2010based testing, self\u2010sampling modalities, and age\u2010adapted pathways in women 65\u2009years and older. Studies meeting prespecified eligibility criteria were included in qualitative synthesis; those providing data for at least one prespecified outcome were included in meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Collection and Analysis<\/jats:title>\n                    <jats:p>Core studies contributing data suitable for quantitative synthesis were analyzed alongside supportive studies addressing participation, acceptability, implementation, and policy\u2010relevant outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Results<\/jats:title>\n                    <jats:p>\n                      The search identified 3461 records; after duplicate removal, 2918 titles\/abstracts were screened and 1704 full texts were assessed. Forty\u2010five studies met inclusion criteria for qualitative synthesis, including 13 core studies eligible for meta\u2010analysis of at least one prespecified outcome. Across the core evidence base, clinically meaningful high\u2010risk HPV positivity and histologically confirmed high\u2010grade lesions were observed beyond conventional exit ages, particularly among women with incomplete prior screening. A strong program\u2010level signal was reported in a Danish catch\u2010up initiative, where uptake was \u224862% in the intervention region versus \u22482% in the reference region, with cervical intraepithelial neoplasia grade 2 or worse detection \u22483.9 per 1000 eligible women compared with\n                      <jats:bold>\u2248<\/jats:bold>\n                      0.3 per 1000 in the reference setting. Self\u2010sampling, including messenger RNA\u2013based approaches, appeared feasible in older women and may reduce barriers related to postmenopausal anatomy and speculum discomfort. Supportive evidence indicates that invitation design and outreach intensity substantially influence participation and downstream pathway efficiency.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The evidence supports recalibrating cervical cancer screening beyond age 65\u2009years using risk\u2010informed HPV\u2010based strategies. Targeted catch\u2010up testing and well\u2010designed self\u2010sampling pathways may improve coverage and detection of clinically relevant disease in select older populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70962","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T11:22:36Z","timestamp":1773314556000},"page":"1205-1217","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cervical cancer screening strategies in women 65\u2009years and older in the human papillomavirus era: A systematic review and meta\u2010analysis of human papillomavirus\u2013based testing and self\u2010sampling approaches"],"prefix":"10.1002","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2279-1822","authenticated-orcid":false,"given":"Ebru","family":"Zulfikaroglu","sequence":"first","affiliation":[{"name":"Eva Women Health Clinic  Ankara 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