BACKGROUND: 

• 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 

METHODS: 

• 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 
• Efficient strategies  
  • More benefit and less harm than another strategy or  
  • Lower harm to benefit ratio than a strategy with less harms 

RESULTS: 

• 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 

CONCLUSION: 

• 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

Learn More- Primary Sources: 

Screening for Cervical Cancer in Primary Care A Decision Analysis for the US Preventive Services Task Force

Related ObG Topics:

Cervical Cancer Screening Guidelines: The Role of Pap and HPV

ASCCP Releases New Colposcopy Guidance:  A Risk-Based Approach

Screening for Cervical Cancer in the Woman at Average Risk