The potential harms of primary human papillomavirus screening in over-screened women: a microsimulation study

Naber, Steffie K.; Kok, Inge M.C.M. de; Matthijsse, Suzette M.; Ballegooijen, Marjolein van

doi:10.1007/s10552-016-0732-7

Cited by 11 publications

(11 citation statements)

References 55 publications

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“…Annual cervical cancer screening is not recommended for women at any age by any modality. Given lower test specificity, over-screening with the HPV test is associated with greater peril than over-screening with the Pap test (Naber et al, 2016). Increased detection of transient HPV infections, particularly in younger women, will augment unnecessary diagnostic procedures and follow-up For over-screened women, HPV testing (either stand alone or co-testing) may cause more harm than benefit.…”

Section: Discussionmentioning

confidence: 99%

Primary HPV testing recommendations of US providers, 2015

Cooper¹,

Saraiya

2017

Preventive Medicine

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Objective To investigate the HPV testing recommendations of US physicians who perform cervical cancer screening. Methods Data from the 2015 DocStyles survey of U.S. health care providers were analyzed using multivariate logistic regression to identify provider characteristics associated with routine recommendation of primary HPV testing for average-risk, asymptomatic women ≥30 years old. The analysis was limited to primary care physicians and obstetrician-gynecologists who performed cervical cancer screening (N = 843). Results Primary HPV testing for average-risk, asymptomatic women ≥30 years old was recommended by 40.8% of physicians who performed cervical cancer screening, and 90.1% of these providers recommended primary HPV testing for women of all ages. The screening intervals most commonly recommended for primary HPV testing with average-risk, asymptomatic women ≥30 years old were every 3 years (35.5%) and annually (30.2%). Physicians who reported that patient HPV vaccination status influenced their cervical cancer screening practices were almost four times more likely to recommend primary HPV testing for average-risk, asymptomatic women ≥30 years old than other providers (Adj OR = 3.96, 95% CI = 2.82–5.57). Conclusion Many US physicians recommended primary HPV testing for women of all ages, contrary to guidelines which limit this screening approach to women ≥25 years old. The association between provider recommendation of primary HPV testing and patient HPV vaccination status may be due to anticipated reductions in the most oncogenic HPV types among vaccinated women.

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Section: Discussionmentioning

confidence: 99%

Primary HPV testing recommendations of US providers, 2015

Cooper¹,

Saraiya

2017

Preventive Medicine

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“…When considering new technologies, financial considerations and formal cost-effectiveness analyses help inform one aspect of the decision-making process; however, other factors such as quantifying resource use and identifying capacity constraints play an important role in establishing the feasibility of population-based implementation. While other modelling studies have quantified resource use ( Stout et al , 2008 ; Naber et al , 2016 ; Smith et al , 2016 ), to our knowledge, isolating the impact primary HPV-based screening and alternative triage approaches have on colposcopy referrals and health benefits have not been explored previously. Our objective was to enumerate the trade-offs in health benefits and resource use associated with adopting primary HPV testing strategies for unvaccinated women using a decision-analytic model.…”

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confidence: 99%

Choosing wisely: a model-based analysis evaluating the trade-offs in cancer benefit and diagnostic referrals among alternative HPV testing strategies in Norway

Burger¹,

Pedersen

Sy³

et al. 2017

Br J Cancer

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Background:Forthcoming cervical cancer screening strategies involving human papillomavirus (HPV) testing for women not vaccinated against HPV infections may increase colposcopy referral rates. We quantified health and resource trade-offs associated with alternative HPV-based algorithms to inform decision-makers when choosing between candidate algorithms.Methods:We used a mathematical simulation model of HPV-induced cervical carcinogenesis in Norway. We compared the current cytology-based strategy to alternative strategies that varied by the switching age to primary HPV testing (ages 25–34 years), the routine screening frequency (every 3–10 years), and management of HPV-positive, cytology-negative women. Model outcomes included reductions in lifetime cervical cancer risk, relative colposcopy rates, and colposcopy rates per cervical cancer prevented.Results:The age of switching to primary HPV testing and the screening frequency had the largest impacts on cancer risk reductions, which ranged from 90.9% to 96.3% compared to no screening. In contrast, increasing the follow-up intensity of HPV-positive, cytology-negative women provided only minor improvements in cancer benefits, but generally required considerably higher rates of colposcopy referrals compared to current levels, resulting in less efficient cervical cancer prevention.Conclusions:We found that in order to maximise cancer benefits HPV-based screening among unvaccinated women should not be delayed: rather, policy makers should utilise the triage mechanism to control colposcopy referrals.

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“…We used 4 well-established CISNET-Cervical microsimulation models (Harvard, 4 Microsimulation Screening Analysis [MISCAN]–Cervix, 5 Policy1-Cervix [CCNSW], 6 and University of Minnesota [UMN]–HPV Cancer [CA] 7 ) to project outcomes for a hypothetical cohort of individual women. This analysis was conducted prior to standardization of each model to the US population and screening performance.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Different Screening Model Structures on Cervical Cancer Incidence and Mortality Predictions: The Maximum Clinical Incidence Reduction (MCLIR) Methodology

et al. 2020

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Background. To interpret cervical cancer screening model results, we need to understand the influence of model structure and assumptions on cancer incidence and mortality predictions. Cervical cancer cases and deaths following screening can be attributed to 1) (precancerous or cancerous) disease that occurred after screening, 2) disease that was present but not screen detected, or 3) disease that was screen detected but not successfully treated. We examined the relative contributions of each of these using 4 Cancer Intervention and Surveillance Modeling Network (CISNET) models. Methods. The maximum clinical incidence reduction (MCLIR) method compares changes in the number of clinically detected cervical cancers and mortality among 4 scenarios: 1) no screening, 2) one-time perfect screening at age 45 that detects all existing disease and delivers perfect (i.e., 100% effective) treatment of all screen-detected disease, 3) one-time realistic-sensitivity cytological screening and perfect treatment of all screen-detected disease, and 4) one-time realistic-sensitivity cytological screening and realistic-effectiveness treatment of all screen-detected disease. Results. Predicted incidence reductions ranged from 55% to 74%, and mortality reduction ranged from 56% to 62% within 15 years of follow-up for scenario 4 across models. The proportion of deaths due to disease not detected by screening differed across the models (21%–35%), as did the failure of treatment (8%–16%) and disease occurring after screening (from 1%–6%). Conclusions. The MCLIR approach aids in the interpretation of variability across model results. We showed that the reasons why screening failed to prevent cancers and deaths differed between the models. This likely reflects uncertainty about unobservable model inputs and structures; the impact of this uncertainty on policy conclusions should be examined via comparing findings from different well-calibrated and validated model platforms.

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The potential harms of primary human papillomavirus screening in over-screened women: a microsimulation study

Cited by 11 publications

References 55 publications

Primary HPV testing recommendations of US providers, 2015

Primary HPV testing recommendations of US providers, 2015

Choosing wisely: a model-based analysis evaluating the trade-offs in cancer benefit and diagnostic referrals among alternative HPV testing strategies in Norway

The Impact of Different Screening Model Structures on Cervical Cancer Incidence and Mortality Predictions: The Maximum Clinical Incidence Reduction (MCLIR) Methodology

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