Details

Autor(en) / Beteiligte

• Simms, Kate T.
• Keane, Adam
• Nguyen, Diep Thi Ngoc
• Caruana, Michael
• Hall, Michaela T.
• Lui, Gigi
• Gauvreau, Cindy
• Demke, Owen
• Arbyn, Marc
• Basu, Partha
• Wentzensen, Nicolas
• Lauby-Secretan, Beatrice
• Ilbawi, Andre
• Hutubessy, Raymond
• Almonte, Maribel
• De Sanjosé, Silvia
• Kelly, Helen
• Dalal, Shona
• Eckert, Linda O.
• Santesso, Nancy
• Broutet, Nathalie
• Canfell, Karen

Titel

Benefits, harms and cost-effectiveness of cervical screening, triage and treatment strategies for women in the general population

Ist Teil von

• Nature medicine, 2023-12, Vol.29 (12), p.3050-3058

Ort / Verlag

New York: Nature Publishing Group US

Erscheinungsjahr

2023

Quelle

MEDLINE

Beschreibungen/Notizen

• In 2020, the World Health Organization (WHO) launched a strategy to eliminate cervical cancer as a public health problem. To support the strategy, the WHO published updated cervical screening guidelines in 2021. To inform this update, we used an established modeling platform, Policy1-Cervix , to evaluate the impact of seven primary screening scenarios across 78 low- and lower-middle-income countries (LMICs) for the general population of women. Assuming 70% coverage, we found that primary human papillomavirus (HPV) screening approaches were the most effective and cost-effective, reducing cervical cancer age-standardized mortality rates by 63–67% when offered every 5 years. Strategies involving triaging women before treatment (with 16/18 genotyping, cytology, visual inspection with acetic acid (VIA) or colposcopy) had close-to-similar effectiveness to HPV screening without triage and fewer pre-cancer treatments. Screening with VIA or cytology every 3 years was less effective and less cost-effective than HPV screening every 5 years. Furthermore, VIA generated more than double the number of pre-cancer treatments compared to HPV. In conclusion, primary HPV screening is the most effective, cost-effective and efficient cervical screening option in LMICs. These findings have directly informed WHO’s updated cervical screening guidelines for the general population of women, which recommend primary HPV screening in a screen-and-treat or screen-triage-and-treat approach, starting from age 30 years with screening every 5 years or 10 years. A modelled evaluation of screening and treatment strategies for prevention of cervical cancer in 78 low- and lower-middle-income countries provides evidence to support the World Health Organization’s recommendation of primary HPV testing for women in the general population.