Rapid elimination of cervical cancer while maintaining the harms and benefits ratio of cervical cancer screening: a modelling study

Abstract

Background Human papillomavirus (HPV) vaccination and intensifying screening expedite cervical cancer (CC) elimination, yet also deteriorate the balance between harms and benefits of screening. We aimed to find screening strategies that eliminate CC rapidly but maintain an acceptable harms-benefits ratio of screening. Methods Two microsimulation models (STDSIM and MISCAN) were applied to simulate HPV transmission and CC screening for the Dutch female population between 2022 and 2100. We estimated the CC elimination year and harms-benefits ratios of screening for 228 unique scenarios varying in vaccination (coverage and vaccine type) and screening (coverage and number of lifetime invitations in vaccinated cohorts). The acceptable harms-benefits ratio was defined as the number of women needed to refer (NNR) to prevent one CC death under the current programme for unvaccinated cohorts (82.17). Results Under current vaccination conditions (bivalent vaccine, 55% coverage in girls, 27.5% coverage in boys), maintaining current screening conditions is projected to eliminate CC by 2042, but increases the present NNR with 41%. Reducing the number of lifetime screens from presently five to three and increasing screening coverage (61% to 70%) would prevent an increase in harms and only delay elimination by 1 year. Scaling vaccination coverage to 90% in boys and girls with the nonavalent vaccine is estimated to eliminate CC by 2040 under current screening conditions, but exceeds the acceptable NNR with 23%. Here, changing from five to two lifetime screens would keep the NNR acceptable without delaying CC elimination. Conclusions De-intensifying CC screening in vaccinated cohorts leads to little or no delay in CC elimination while it substantially reduces the harms of screening. Therefore, de-intensifying CC screening in vaccinated cohorts should be considered to ensure acceptable harms-benefits ratios on the road to CC elimination.

Strategies to accelerate the elimination of cervical cancer in British Columbia, Canada: a modelling study

“…A study from the Netherlands found that increasing vaccine coverage to 90% and reducing the number of lifetime screens among vaccinated women could eliminate cervical cancer while maintaining follow-up referral rates at current levels. 28 Similarly, modelling from China found that a strategy in which screening is scaled back as vaccinated cohorts age through the population was most cost effective. 36 Reducing screening frequency or modifying triage and follow-up pathways based on vaccination status may be tools to support the implementation of HPV-based screening and reduce unnecessary follow-up testing.…”

“…25 Using HPV-based screening, the elimination threshold should be achieved in 2025 in Australia (8 yr after implementation), 26 2035 in Norway (15 yr after implementation), 27 and 2042 in the Netherlands, where low-frequency (every 5 yr starting at age 30 yr, then every 10 yr for people with a negative screen at age 40 yr) HPV screening has been offered since 2017. 28 Although screening program design, vaccination coverage, and screening participation vary across jurisdictions, previous studies consistently report that adoption of HPV-based screening and increasing on-time participation have the largest impact on projected incidence. 25,[27][28][29] Increasing on-time screening participation among neverscreened and underscreened individuals, or increasing adherence to recommended follow-up would have the largest impact on eliminating cervical cancer in a shorter time frame.…”

“…28 Although screening program design, vaccination coverage, and screening participation vary across jurisdictions, previous studies consistently report that adoption of HPV-based screening and increasing on-time participation have the largest impact on projected incidence. 25,[27][28][29] Increasing on-time screening participation among neverscreened and underscreened individuals, or increasing adherence to recommended follow-up would have the largest impact on eliminating cervical cancer in a shorter time frame. Both scenarios achieved the elimination threshold 2 years earlier than the HPV base case.…”

Study on the effect of TP chemotherapy regimen combined with Qinggong detoxification soup on the clinical efficacy of cervical cancer patients

“…Clinical statistics have indicated that the incidence of cervical cancer in China is higher than the global average and the size of the patient population is very large [1]. At present, clinical treatment for cervical cancer is mainly based on surgical treatment and radiotherapy [2]. However, some cervical cancer patients have missed the window for surgical treatment and are unable to have surgery since they are frequently diagnosed in the middle and late stages of the cancer [3].…”