Harms and benefits of cervical cancer screening among non-attenders in Switzerland: The transition towards HPV-based screening
Human papillomavirus (HPV) testing is replacing cytological screening for cervical cancer. Our aim was to assess the expected benefits and harms of different cervical screening strategies. This study is sub-analysis of a previous cost-effectiveness study with a target population of unscreened women...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-10-01
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| Series: | Preventive Medicine Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211335522002364 |
| _version_ | 1828147686260342784 |
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| author | Rosa Catarino Pierre Vassilakos Patrick Petignat Christophe Combescure |
| author_facet | Rosa Catarino Pierre Vassilakos Patrick Petignat Christophe Combescure |
| author_sort | Rosa Catarino |
| collection | DOAJ |
| description | Human papillomavirus (HPV) testing is replacing cytological screening for cervical cancer. Our aim was to assess the expected benefits and harms of different cervical screening strategies. This study is sub-analysis of a previous cost-effectiveness study with a target population of unscreened women without cervical cancer aged ≥ 25 years. A recursive decision-tree with one-year cycles was used to model the life-long natural HPV history. Markov cohort simulations were used to assess the expected outcomes from the model. The outcomes of three strategies were compared with the absence of screening: HPV-testing on self-collected vaginal samples (Self-HPV) followed by colposcopy (Self-HPV/colpo), Self-HPV and triage with cytology (Self-HPV/PAP), cytology and triage with HPV (PAP/HPV). All screening strategies resulted in reductions in cancer cases and deaths. Self-HPV strategies were associated with a lower cancer incidence and mortality life-long, not only when performed every 3 years but also when Self-HPV was performed every 5 years vs cytology every 3 years. The gain in life expectancy obtained was 82 days with Self-HPV/colpo, 81 days with Self-HPV/PAP and 75 days with PAP/HPV compared to no screening. The number of lifetime total visits was greater with PAP/HPV compared with the Self-HPV strategies (13.13 vs < 3). The number of conizations remained relatively stable with the change of screening frequency and strategy. Self-HPV may represent a reasonable balance of harms and benefits when performed every 5 years compared to cytology every 3 years. Self-HPV/PAP yielded the most efficient harm to benefit ratio when using colposcopy as a proxy for harms. |
| first_indexed | 2024-04-11T21:03:51Z |
| format | Article |
| id | doaj.art-466601b6b90b4432aec565e61a7db935 |
| institution | Directory Open Access Journal |
| issn | 2211-3355 |
| language | English |
| last_indexed | 2024-04-11T21:03:51Z |
| publishDate | 2022-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Preventive Medicine Reports |
| spelling | doaj.art-466601b6b90b4432aec565e61a7db9352022-12-22T04:03:24ZengElsevierPreventive Medicine Reports2211-33552022-10-0129101929Harms and benefits of cervical cancer screening among non-attenders in Switzerland: The transition towards HPV-based screeningRosa Catarino0Pierre Vassilakos1Patrick Petignat2Christophe Combescure3Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland; Corresponding author at: Division of Gynaecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland.Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland; Geneva Foundation for Medical Education and Research, Route de Ferney 150, 1211 Geneva, SwitzerlandDepartment of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, SwitzerlandDivision of Clinical Epidemiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, SwitzerlandHuman papillomavirus (HPV) testing is replacing cytological screening for cervical cancer. Our aim was to assess the expected benefits and harms of different cervical screening strategies. This study is sub-analysis of a previous cost-effectiveness study with a target population of unscreened women without cervical cancer aged ≥ 25 years. A recursive decision-tree with one-year cycles was used to model the life-long natural HPV history. Markov cohort simulations were used to assess the expected outcomes from the model. The outcomes of three strategies were compared with the absence of screening: HPV-testing on self-collected vaginal samples (Self-HPV) followed by colposcopy (Self-HPV/colpo), Self-HPV and triage with cytology (Self-HPV/PAP), cytology and triage with HPV (PAP/HPV). All screening strategies resulted in reductions in cancer cases and deaths. Self-HPV strategies were associated with a lower cancer incidence and mortality life-long, not only when performed every 3 years but also when Self-HPV was performed every 5 years vs cytology every 3 years. The gain in life expectancy obtained was 82 days with Self-HPV/colpo, 81 days with Self-HPV/PAP and 75 days with PAP/HPV compared to no screening. The number of lifetime total visits was greater with PAP/HPV compared with the Self-HPV strategies (13.13 vs < 3). The number of conizations remained relatively stable with the change of screening frequency and strategy. Self-HPV may represent a reasonable balance of harms and benefits when performed every 5 years compared to cytology every 3 years. Self-HPV/PAP yielded the most efficient harm to benefit ratio when using colposcopy as a proxy for harms.http://www.sciencedirect.com/science/article/pii/S2211335522002364Cervical cancer screeningDeveloped countriesHarmsHPV testingScreening frequencySelf-HPV |
| spellingShingle | Rosa Catarino Pierre Vassilakos Patrick Petignat Christophe Combescure Harms and benefits of cervical cancer screening among non-attenders in Switzerland: The transition towards HPV-based screening Preventive Medicine Reports Cervical cancer screening Developed countries Harms HPV testing Screening frequency Self-HPV |
| title | Harms and benefits of cervical cancer screening among non-attenders in Switzerland: The transition towards HPV-based screening |
| title_full | Harms and benefits of cervical cancer screening among non-attenders in Switzerland: The transition towards HPV-based screening |
| title_fullStr | Harms and benefits of cervical cancer screening among non-attenders in Switzerland: The transition towards HPV-based screening |
| title_full_unstemmed | Harms and benefits of cervical cancer screening among non-attenders in Switzerland: The transition towards HPV-based screening |
| title_short | Harms and benefits of cervical cancer screening among non-attenders in Switzerland: The transition towards HPV-based screening |
| title_sort | harms and benefits of cervical cancer screening among non attenders in switzerland the transition towards hpv based screening |
| topic | Cervical cancer screening Developed countries Harms HPV testing Screening frequency Self-HPV |
| url | http://www.sciencedirect.com/science/article/pii/S2211335522002364 |
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