The significantly lower risk of cervical cancer at and after the recommended age to begin and end screening compared to breast and colorectal cancer

Whitham, Hilary K.; Kulasingam, Shalini

doi:10.1016/j.ypmed.2015.01.035

Cited by 3 publications

(4 citation statements)

References 54 publications

(64 reference statements)

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“…A recent cross-cancer comparison of disease burden and screening practices for women in the US showed that guidelines propose the age to start screening for breast and colorectal cancer at a point in life (50 years) when the underlying risk of these diseases is much higher than for cervical cancer at the onset of screening (21 years) [53]. At all ages, breast and colorectal cancers are much more common than cervical cancer.…”

Section: Analogy With Other Screening Activities In Cancer Preventionmentioning

confidence: 99%

“…Colorectal cancer in particular is a good example of a disease much like cervical cancer, i.e., screening leads to the discovery of a precancerous state (adenomas) that is amenable to treatment and there is proof of mortality reduction from screening. Yet, risk of high-grade cervical lesions at age 21 is about 50 times lower than the rate of colorectal adenomas in women at age 50, the age of onset of colorectal cancer screening [53]. This indicates that, for the US at least, there is far less tolerance of risk for cervical cancer than there is for colorectal cancer, despite the fact that these two diseases imply comparably unfavourable prognosis for the patients.…”

Section: Analogy With Other Screening Activities In Cancer Preventionmentioning

confidence: 99%

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Cervical cancer screening of HPV vaccinated populations: Cytology, molecular testing, both or none

El‐Zein

Richardson

Franco

2016

Journal of Clinical Virology

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Cervical cancer control includes primary prevention through vaccination to prevent human papillomavirus (HPV) infection and secondary prevention through screening to detect and treat cervical precancerous lesions. This review summarizes the evidence for the population impact of vaccines against oncogenic HPV types in reducing the prevalence of cervical precancerous lesions. We examine the gradual shift in screening technology from cervical cytology alone to cytology and HPV cotesting, and finally to the recognition that HPV testing can serve alone as the new screening paradigm, particularly in the initial post-vaccination era. We should expect an impact on screening performance and practices, as cohorts of HPV-vaccinated girls and adolescents reach cervical cancer screening age. In preparation for changes in the screening paradigm for the vaccination era, we propose that policymaking on cervical cancer screening should mirror current practices with other cancers as benchmarks. Cervical precancerous lesions will become a very rare condition following the widespread implementation of HPV vaccines with broader coverage in the number of preventable oncogenic types. Irrespective of screening technology, the false positive results will far outnumber the true positive ones, a tipping point that will herald a new period when the harms from cervical cancer screening will outweigh its benefits. We present a conceptual framework to guide decision making when we reach this point within 25–30 years.

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Section: Analogy With Other Screening Activities In Cancer Preventionmentioning

confidence: 99%

Section: Analogy With Other Screening Activities In Cancer Preventionmentioning

confidence: 99%

Cervical cancer screening of HPV vaccinated populations: Cytology, molecular testing, both or none

El‐Zein

Richardson

Franco

2016

Journal of Clinical Virology

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“…To the best of our knowledge, guideline committees do not compare risk across cancer sites. In 2015, Whitham and Kulasingam evaluated risk of cervical cancer at and after the recommended age to begin and end screening in relation to risk of breast and colorectal cancers, revealing the higher propensity to screen for cervical cancer despite lower risk 40 . Our analysis comparing incidence and survival across cancer sites for which screening is recommended and not recommended, to assess tolerable risk, is an extension of this approach.…”

Section: Conclusion and Perspectivementioning

confidence: 99%

Defining benchmarks for tolerable risk thresholds in cancer screening: Impact of HPV vaccination on the future of cervical cancer screening

Tota

Isidean

Franco

2020

Intl Journal of Cancer

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The performance of cervical cancer screening will decline as a function of lower disease prevalence-a consequence of successful human papillomavirus (HPV) vaccination. Replacement of cytology with molecular HPV testing as the primary screening test and adoption of risk-based screening, with less intense screening of vaccinated individuals and initiated at older ages is expected to improve efficiency. However, policy officials may decide to further reduce or eliminate screening as the ratio of benefits to harms continues to decline. To evaluate the level of risk currently tolerated for different cancers in the United States (ie, for which clinical guidelines do not recommend secondary prevention though effective screening methods exist), we used US cancer registry data to compare incidence (2008-2012) and survival (1988-2011) associated with different cancers for which organized screening is recommended and not recommended. The most common cancer at ages 70 to 74 years (ie, age group with highest cancer incidence and reasonable life expectancy to consider screening in the US) satisfying Wilson and Jungner's classic screening criteria was vulvar cancer (incidence = 9/100 000 females). In comparison, the incidence of cervical cancer among females 65 years of age (the upper recommended age limit for screening) was 13 cases per 100 000 females (low as a reflection of effective screening), whereas 10-year survival was 66% (similar to vulvar cancer at 67%). Our approach of defining tolerable risk in cancer screening could help guide future decisions to modify cervical screening programs.

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“…A compelling line of reasoning for gauging the importance of the cancer burden that justifies screening was advanced in this issue of Preventive Medicine by Whitham and Kulasingam (2015-in this issue). These authors used data from the Surveillance, Epidemiology, and End Results (SEER) program maintained by the US National Cancer Institute to compare the risk of breast, colon, and cervical cancer at and after the recommended ages for screening.…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 99%

Sobering realizations in cancer prevention and screening and their lessons

Franco

Shinder

Tota

et al. 2015

Preventive Medicine

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The significantly lower risk of cervical cancer at and after the recommended age to begin and end screening compared to breast and colorectal cancer

Cited by 3 publications

References 54 publications

Cervical cancer screening of HPV vaccinated populations: Cytology, molecular testing, both or none

Cervical cancer screening of HPV vaccinated populations: Cytology, molecular testing, both or none

Defining benchmarks for tolerable risk thresholds in cancer screening: Impact of HPV vaccination on the future of cervical cancer screening

Sobering realizations in cancer prevention and screening and their lessons

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