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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
Open accessAbstract
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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Metadata
- 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
- ORCID
- 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
- gold
- doi.org
- Licence
- 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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