Adjustment of cervical cancer screening protocols as a woman ages may be cost-effective, regardless of whether she has been vaccinated against the human papillomavirus (HPV) that causes cervical cancer.
Since the release of cervical cancer screening guidelines in 2001 and 2003, more data has become available showing that HPV DNA-based testing is more effective in detecting precancerous changes in a woman's cervix than standard cytology (Pap) tests. With these data and the development of a vaccine that prevents two types of HPV infection, analyses are needed that estimate both the effectiveness and cost of different screening strategies for U.S. women.
Using information about the frequency with which girls of different ages become infected with HPV and the likelihood that a persistent infection will lead to cancer, Sue J. Goldie, M.D., of Harvard School of Public Health in Boston and colleagues mathematically modeled the impact of each available screening technique in vaccinated and unvaccinated women. While a number of acceptable strategies were identified, the researchers found that the most cost-effective screening protocols for both vaccinated and unvaccinated women included cytology during the early part of a woman's life, followed by HPV DNA-based screening after age 30. This strategy differs from most commonly used screening practices.
The investigators emphasized that the frequency of screening could be reduced in vaccinated individuals and the switch to DNA-based screening delayed by five years, relative to unvaccinated women. The researchers estimated that cervical cancer risk could be reduced by an additional 30 percent in future generations of American women provided there is high vaccine coverage in preadolescent girls, continued screening in vaccinated and unvaccinated women, and targeted efforts to recruit and screen women with historically poor access to cervical cancer prevention.
"Our findings indicate that it may be worthwhile to consider strategies that differ according to age and vaccination status and to revisit screening options recommended for older women," the authors write.
In an accompanying editorial, Nancy Kiviat, M.D., of Harborview Medical Center in Seattle, and colleagues write "The analyses presented [here] will undoubtedly support the urgently needed development of screening recommendations for the immediate future."
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