Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study

Xia, Changfa; Xu, Xiaoqian; Zhao, Xuelian; Hu, Shangying; Qiao, You‐Lin; Zhang, Yong; Hutubessy, Raymond; Basu, Partha; Broutet, Nathalie; Jit, Mark; Zhao, Fen

doi:10.1186/s12916-021-01930-9

Cited by 24 publications

(37 citation statements)

References 34 publications

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“…Only if China adopts a comprehensive strategy, including human papillomavirus vaccination, cervical screening, and treatment of pre-invasive lesions and invasive cancer, then cervical cancer could be eliminated by the late 2040s, with potential economic benefits. [31] The 5-year relative survival rate in cancer increased from 30.9% in 2003-2005 to 40.5% in 2012-2015 in China. [32] However, the survival rates for specific cancer types were lower in China than the USA, especially breast and colorectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Cancer statistics in China and United States, 2022: profiles, trends, and determinants

Xia

Dong

et al. 2022

Chinese Medical Journal

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Background:The cancer burden in the United States of America (USA) has decreased gradually. However, China is experiencing a transition in its cancer profiles, with greater incidence of cancers that were previously more common in the USA. This study compared the latest cancer profiles, trends, and determinants between China and USA.Methods:This was a comparative study using open-source data. Cancer cases and deaths in 2022 were calculated using cancer estimates from GLOBOCAN 2020 and population estimates from the United Nations. Trends in cancer incidence and mortality rates in the USA used data from the Surveillance, Epidemiology, and End Results program and National Center for Health Statistics. Chinese data were obtained from cancer registry reports. Data from the Global Burden of Disease 2019 and a decomposition method were used to express cancer deaths as the product of four determinant factors.Results:In 2022, there will be approximately 4,820,000 and 2,370,000 new cancer cases, and 3,210,000 and 640,000 cancer deaths in China and the USA, respectively. The most common cancers are lung cancer in China and breast cancer in the USA, and lung cancer is the leading cause of cancer death in both. Age-standardized incidence and mortality rates for lung cancer and colorectal cancer in the USA have decreased significantly recently, but rates of liver cancer have increased slightly. Rates of stomach, liver, and esophageal cancer decreased gradually in China, but rates have increased for colorectal cancer in the whole population, prostate cancer in men, and other seven cancer types in women. Increases in adult population size and population aging were major determinants for incremental cancer deaths, and case-fatality rates contributed to reduced cancer deaths in both countries.Conclusions:The decreasing cancer burden in liver, stomach, and esophagus, and increasing burden in lung, colorectum, breast, and prostate, mean that cancer profiles in China and the USA are converging. Population aging is a growing determinant of incremental cancer burden. Progress in cancer prevention and care in the USA, and measures to actively respond to population aging, may help China to reduce the cancer burden.

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Section: Discussionmentioning

confidence: 99%

Cancer statistics in China and United States, 2022: profiles, trends, and determinants

Xia

Dong

et al. 2022

Chinese Medical Journal

Self Cite

1,973

1,013

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“…An area of future investigation may be to apply different screening frequencies depending on if a cohort is vaccinated, as has been modeled in other settings such as China. 54 …”

Section: Discussionmentioning

confidence: 99%

The road to cervical cancer elimination in Malaysia: Evaluation of the impact and cost‐effectiveness of human papillomavirus screening with self‐collection and digital registry support

Keane

Simms

et al. 2021

Intl Journal of Cancer

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The WHO has launched a global strategy to eliminate cervical cancer through the scale-up of human papillomavirus (HPV) vaccination, cervical screening, and cervical cancer treatment. Malaysia has achieved high-coverage HPV vaccination since 2010, but coverage of the existing cytology-based program remains low. Pilot studies found HPV self-sampling was acceptable and effective, with high follow-up rates when a digital registry was used, and recently the Malaysian Government announced plans for a national HPV-based screening program. We therefore evaluated the impact of primary HPV screening with self-collection in Malaysia in the context of Malaysia's existing vaccination program. We used the "Policy1-Cervix" modeling platform to assess health outcomes, cost-effectiveness, resource use and cervical cancer elimination timing (the year when cervical cancer rates reach four cases per 100 000 women) of implementing primary HPV testing with self-collection, assuming 70% routine-screening coverage could be achieved. Based on available data, we assumed that compliance with follow-up was 90% when a digital registry was used, but that compliance with follow-up would be 50-75% without the use of a digital registry. We found that the current vaccination program would prevent 27 000 to 32 200 cervical cancer cases and 11 700 to 14 000 deaths by 2070. HPV testing with a digital registry was cost-effective (CER = $US 6953-7549 < $US 11 373[<1ÂGDP per capita]) and could prevent an additional 15 900 to 17 800 cases and 9700 to 10 600 deaths by 2070, expediting national elimination by 11 to 20 years, to 2055 to 2059. If HPV screening were implemented without a digital registry, there would be 1800 to 4900 fewer deaths averted by 2070 and the program would be less cost-effective. These results underline the importance of HPV testing as a key elimination pillar in Malaysia.

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“…Screening and early treatment to prevent the disease can thus lead to a better prognosis and reduce the morbidity and mortality due to the illness [11]. Several cost-effective strategies combining human papillomavirus vaccination, cervical screening, and treatment have proven to be suitable for low-resource settings [12] and found effective in LMICs like India [13]. Methods like HPV testing could replace expensive colposcopy procedures in LMICs where resources are scare and the burden of cervical cancer is high [14].…”

Section: Introductionmentioning

confidence: 99%

A comparison of behavioural models explaining cervical cancer screening uptake

et al. 2022

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Background Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention. Methods A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models. Results CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers. Conclusion Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women’s screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening.

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Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study

Cited by 24 publications

References 34 publications

Cancer statistics in China and United States, 2022: profiles, trends, and determinants

Cancer statistics in China and United States, 2022: profiles, trends, and determinants

The road to cervical cancer elimination in Malaysia: Evaluation of the impact and cost‐effectiveness of human papillomavirus screening with self‐collection and digital registry support

A comparison of behavioural models explaining cervical cancer screening uptake

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