What is the Most Efficient Method for Cervical Cancer Screening?
As part of the evidence report for the new USPSTF recommendations for cervical cancer screening recently released (see ‘Related ObG Topics’ below), a decision analysis using a disease simulation model was constructed
Kim et al. (JAMA, 2018) modeled the benefits and harms of various cervical cancer screening strategies
Microsimulation model of a hypothetical cohort of women initiating screening at age 21 years
The models looked at 19 strategies for cervical cancer screening, including 2 previous guideline-based strategies
Previous guideline strategy 1: Cytology alone every 3 years from ages 21 to 65 years
Previous guideline strategy 2: Cytology alone every 3 years from ages 21 to 29 years, with a switch to cytology and hrHPV cotesting every 5 years from ages 30 to 65 years
Primary HPV testing strategies
Outcomes assessed risks and benefits
Harms: Total number of cytology and hrHPV tests (including screening, triage, and surveillance) | Colposcopies | FP screening results
Benefits: CIN 2 and CIN 3 detected | CIN 3 or worse (CIN 3+) detected (including CIN 3 and cervical cancers detected through screening) | Cervical cancer cases and deaths averted | Life-years gained
More benefit and less harm than another strategy or
Lower harm to benefit ratio than a strategy with less harms
Compared with no screening, all modeled cervical cancer screening strategies were estimated to result in substantial reductions in cancer cases and deaths and gains in life-years
The effectiveness of screening across the different strategies was estimated to be similar
Primary hrHPV-based and alternative cotesting strategies have slightly higher effectiveness and greater harms than current guidelines-based cytology testing
In all analyses, primary hrHPV testing strategies occurring at 5-year intervals were efficient
In contrast, strategies involving 3-year hrHPV testing was less efficient with much higher harm/benefit ratios, ranging from 2188 to 3822 colposcopies per life-year gained
In most analyses, strategies involving cotesting were not efficient
From modeling, it was estimated that primary hrHPV screening demonstrated a reasonable balance of harms and benefits when performed every 5 years
The most efficient harm/benefit strategy was converting from cytology to hrHPV at age 30
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