Benefits and Costs of Using HPV Testing to Screen for Cervical Cancer

Mandelblatt, Jeanne S.

doi:10.1001/jama.287.18.2372

Cited by 268 publications

(243 citation statements)

References 116 publications

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“…Thus, the true estimate for specificity for the Pap smear is probably in the upper end of the confidence or credible interval, i.e. closer to 0.90, which is consistent with estimates used in published decisionanalytic models for cervical cancer screening [7]. It is clear that the data used in this analysis is somewhat inconsistent with result, which is based on very large data sets.…”

Section: Discussionsupporting

confidence: 83%

Bayesian meta-analysis of Papanicolaou smear accuracy

Cong

Cox

Cantor

2007

Gynecologic Oncology

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Objective-To perform a Bayesian analysis of data from a previous meta-analysis of Papanicolaou (Pap) smear accuracy (Fahey et al. Am J Epidemiol 1995; 141:680-689) and compare the results.Methods-We considered two Bayesian models for the same dataset used in the Fahey et al study.Model I was a beta-binomial model which considered the number of true positives and false negatives as independent binomial random variables with probability parameters β (sensitivity) and a (one minus specificity), respectively. We assumed that β and a are independent, each following a beta distribution with exponential priors. Model II considered sensitivity and specificity jointly through a bivariate normal distribution on the logits of the sensitivity and specificity. We performed sensitivity analysis to examine the effect of prior selection on the parameter estimates.Results-We compared the estimates of average sensitivity and specificity from the Bayesian models with those from Fahey et al.'s SROC approach. Model I produced results similar to those of the SROC approach. Model II produced point estimates higher than those of the SROC approach, although the credible intervals overlapped and were wider. Sensitivity analysis showed that the Bayesian models are somewhat sensitive to the variance of the prior distribution, but their point estimates are more robust than those of the SROC approach. Conclusions-TheBayesian approach has advantages over the SROC approach in that it accounts for between-study variation and allows for estimating the sensitivity and specificity for a particular trial, taking into consideration the results of other trials, i.e., "borrowing strength" from other trials.

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Section: Discussionsupporting

confidence: 83%

Bayesian meta-analysis of Papanicolaou smear accuracy

Cong

Cox

Cantor

2007

Gynecologic Oncology

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“…The development of sensitive and cost-effective tests for high-risk types of the human papillomavirus (HPV) (Cuzick and Sasieni, 1997;Kim et al, 2002;Mandelblatt et al, 2002), the primary causal agent of cervical cancer (Munoz et al, 1992;Schiffman, 1993;Bosch et al, 1995), suggests that HPV testing in triage and primary screening may be a feasible and attractive adjunct to conventional cytological screening (Cuzick et al, 2000;Solomon et al, 2001;Sasieni and Cuzick, 2002). The UK Department of Health, the Medical Research Council/National Health Service and the US National Cancer Institute are currently running trials of HPV screening for women at triage (UK National Screening Committee, 2000; Schiffman and Adrianza, 2000).…”

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confidence: 99%

Attitudes towards HPV testing: a qualitative study of beliefs among Indian, Pakistani, African-Caribbean and white British women in the UK

et al. 2003

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This study examined attitudes to human papillomavirus (HPV) testing among a purposively selected sample of women from four ethnic groups: white British, African Caribbean, Pakistani and Indian. The design was qualitative, using focus group discussion to elicit women's attitudes towards HPV testing in the context of cervical cancer prevention. The findings indicate that although some women welcomed the possible introduction of HPV testing, they were not fully aware of the sexually transmitted nature of cervical cancer and expressed anxiety, confusion and stigma about HPV as a sexually transmitted infection. The term 'wart virus', often used by medical professionals to describe high-risk HPV to women, appeared to exacerbate stigma and confusion. Testing positive for HPV raised concerns about women's sexual relationships in terms of trust, fidelity, blame and protection, particularly for women in longterm monogamous relationships. Participation in HPV testing also had the potential to communicate messages of distrust, infidelity and promiscuity to women's partners, family and community. Concern about the current lack of available information about HPV was clearly expressed and public education about HPV was seen as necessary for the whole community, not only women. The management of HPV within cervical screening raises important questions about informed participation. Our findings suggest that HPV testing has the potential to cause psychosocial harm to women and their partners and families.

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“…The estimates were insensitive to changes in the sensitivity of cytology (varied from 70-90%) and are comparable to symptom rates used in other models. 12,14,15 HrHPV-negative lesions It is assumed that hrHPV is the only causative agent for a CIN3 lesion but that CIN1 and CIN2 lesions may be caused by other types of infections, including low-risk HPV (Fig. 1).…”

Section: Detection Of Cancermentioning

confidence: 99%

“…[12][13][14][15][16] Simulation enables us to combine the results of several studies, compare a large number of scenarios and provides an assessment of the costs and effectiveness in preventing cancer. A simulation model requires the specification of an underlying natural history model that describes health trajectories of women in an unscreened population.…”

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confidence: 99%

Natural history and screening model for high‐risk human papillomavirus infection, neoplasia and cervical cancer in the Netherlands

Berkhof

Bruijne

Zielinski

et al. 2005

Intl Journal of Cancer

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A simulation model is presented that assumes that persistent infection with high-risk human papillomavirus (hrHPV) is a necessary cause of cervical cancer. For the estimation of the model parameters, data of recent Dutch follow-up studies were reanalyzed. The predicted incidences of cervical cancer, cervical intraepithelial neoplasia (CIN1, CIN2 and CIN3) and abnormal cytology were validated with nationwide figures and population-based screening results. The model predicted a lifetime risk for cervical cancer of 2.9% with a peak at age 48 years. The predicted lifetime risk dropped to 0.4% when attending cervical screening. For women who were not hrHPV infected at 30 years, the lifetime risk was 1.6%. Sensitivity analyses were performed to check natural history assumptions that were only weakly identified from available data sets. The incidence of CIN3 observed with screening appeared a useful clinical end point as the predicted incidence was robust against changes in the sensitivity of cervical cytology and the duration to CIN3. The model can be used to study the healtheconomic benefits that can be achieved in nationwide screening when including an hrHPV test. ' 2005 Wiley-Liss, Inc.Key words: cervical neoplasms; cytology; cost effectiveness; human papillomavirus; longitudinal studies; models; screening Population-based screening is regarded as an effective method for reducing the incidence of invasive cervical cancer. Epidemiologic studies report that in countries where cytologic screening has been implemented, the incidence of cervical cancer has shown a larger decrease than in countries without screening. 1,2 Although many countries subscribe to the necessity of screening, each country has its own screening program and different opinions about the optimal program remain.Because persistent infection with the high-risk human papillomavirus (hrHPV) is the key causative agent of cervical cancer, 3,4 many recent and ongoing longitudinal studies have examined whether a test for detection of hrHPV in addition to cytologic inspection increases the efficacy of screening. 5-9 Combined screening (hrHPV and cytology) leads to an earlier detection of women who are at risk for developing high-grade lesions 10 and has a higher sensitivity for the detection of high-grade lesions. 11 However, hrHPV testing also induces extra screening costs so that the determination of the optimal screening scenario involves an elaborate cost-effectiveness analysis.An attractive way to study the efficacy of different screening scenarios is simulation modeling. 12-16 Simulation enables us to combine the results of several studies, compare a large number of scenarios and provides an assessment of the costs and effectiveness in preventing cancer. A simulation model requires the specification of an underlying natural history model that describes health trajectories of women in an unscreened population. We present a natural history model for women in the Netherlands between 30 and 80 years of age and apply the model to predict the incidence of ne...

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Benefits and Costs of Using HPV Testing to Screen for Cervical Cancer

Abstract: Screening with HPV plus Pap tests every 2 years appears to save additional years of life at reasonable costs compared with Pap testing alone. Applying age limits to screening is a viable option to maintain benefits while reducing costs.

Cited by 268 publications

References 116 publications

Bayesian meta-analysis of Papanicolaou smear accuracy

Bayesian meta-analysis of Papanicolaou smear accuracy

Attitudes towards HPV testing: a qualitative study of beliefs among Indian, Pakistani, African-Caribbean and white British women in the UK

Natural history and screening model for high‐risk human papillomavirus infection, neoplasia and cervical cancer in the Netherlands

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