Cited by 160Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program

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Lew, Jie-Bin, Simms, Kate T, Smith, Megan A, Hall, Michaela, Kang, Yoon-Jung, Xu, Xiang Ming, Caruana, Michael, Velentzis, Louiza Sofia +4 more·2017·The Lancet Public Health

Abstract

BACKGROUND: Australia's National Cervical Screening Program currently recommends cytological screening every 2 years for women aged 18-69 years. Human papillomavirus (HPV) vaccination was implemented in 2007 with high population coverage, and falls in high-grade lesions in young women have been reported extensively. This decline prompted a major review of the National Cervical Screening Program and new clinical management guidelines, for which we undertook this analysis. METHODS: We did effectiveness modelling and an economic assessment of potential new screening strategies, using a model of HPV transmission, vaccination, natural history, and cervical screening. First, we evaluated 132 screening strategies, including those based on cytology and primary HPV testing. Second, after a recommendation was made to adopt primary HPV screening with partial genotyping and direct referral to colposcopy of women positive for HPV16/18, we evaluated the final effect of HPV screening after incorporating new clinical guidelines for women positive for HPV. Both evaluations considered both unvaccinated and vaccinated cohorts. FINDINGS: Strategies entailing HPV testing every 5 years and either partial genotyping for HPV16/18 or cytological co-testing were the most effective. One of the most effective and cost-effective strategies comprised primary HPV screening with referral of women positive for oncogenic HPV16/18 direct to colposcopy, with reflex cytological triage for women with other oncogenic types and direct referral for those in this group with high-grade cytological findings. After incorporating detailed clinical guidelines recommendations, this strategy is predicted to reduce cervical cancer incidence and mortality by 31% and 36%, respectively, in unvaccinated cohorts, and by 24% and 29%, respectively, in cohorts offered vaccination. Furthermore, this strategy is predicted to reduce costs by up to 19% for unvaccinated cohorts and 26% for cohorts offered vaccination, compared with the current programme. INTERPRETATION: Primary HPV screening every 5 years with partial genotyping is predicted to be substantially more effective and potentially cost-saving compared with the current cytology-based screening programme undertaken every 2 years. These findings underpin the decision to transition to primary HPV screening with partial genotyping in the Australian National Cervical Screening Program, which will occur in May, 2017. FUNDING: Department of Health, Australia.

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  1. IARC Working Group on the Evaluation of Cancer. IARC Handbooks of Cancer Prevention, vol 10: cervix cancer screening. Lyon: IARC Press, 2005.

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Authors
Lew, J.-B., Simms, K. T., Smith, M. A., Hall, M., Kang, Y.-J., Xu, X. M., Caruana, M., Velentzis, L. S., Bessell, T., Saville, M., Hammond, I., & Canfell, K.
Affiliations
  • Cancer Council NSW (AU)
  • The University of Sydney (AU)
  • Department of Health and Aged Care (AU)
  • The University of Melbourne (AU)
  • The University of Western Australia (AU)
Corresponding author
Canfell, Karen
Venue
The Lancet Public Health
Publisher
Elsevier BV
Published
2017-02
Volume
2
Issue
2
Pages
e96-e107
ISSN
2468-2667 (ISSN-L)
OpenAlex
W2586260676
Cited by
160
References
26
Citations by year
2026: 6 · 2025: 12 · 2024: 11 · 2023: 13 · 2022: 17 · 2021: 19 · 2020: 32 · 2019: 25 · 2018: 19 · 2017: 6
FWCI
17.57
Type
journal article
Language
en
Open access
Locations
  • The Lancet Public Health (publishedVersion, cc-by-nc-nd)
  • UWA Profiles and Research Repository (UWA) (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
Funders
  • Multiple System Atrophy Coalition
  • National Health and Medical Research Council (1082989, 440200, 1007518)
  • Cancer Council NSW
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
primary HPV testing, cervical cancer screening, HPV vaccination, HPV genotyping, HPV 16/18, colposcopy referral, cervical cancer incidence and mortality, cost-effectiveness, National Cervical Screening Program
MeSH terms
Adolescent, Adult, Aged, Australia, Uterine Cervical Neoplasms, Cost-Benefit Analysis, Cell Biology, Diagnostic Tests, Routine, Female, Humans, Middle Aged, Primary Prevention, Program Evaluation, Papillomavirus Infections, Papillomavirus Vaccines, Early Detection of Cancer, Young Adult

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