Cited by 108Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

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

Open access
Simms, Kate T., Keane, Adam, Nguyen, Diep Thi Ngoc, Caruana, Michael, Hall, Michaela T., Lui, Gigi, Gauvreau, Cindy, Demke, Owen +14 more·2023·Nature Medicine

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Abstract

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.

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  1. [6]World Health Organization. WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. https://apps.who.int/iris/bitstream/handle/10665/94830/9789241548694_eng.pdf?sequence=1 (2013). 24716265
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  6. [41]Simms KT Cost-effectiveness of the next generation nonavalent human papillomavirus vaccine in the context of primary human papillomavirus screening in Australia: a comparative modelling analysis Lancet Public Health 2017 1 e66 e75 29253419

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Authors
Simms, K. T., Keane, A., Nguyen, D. T. N., Caruana, M., Hall, M. T., Lui, G., Gauvreau, C., Demke, O., Arbyn, M., Basu, P., Wentzensen, N., Lauby-Secretan, B., Ilbawi, A., Hutubessy, R., Almonte, M., De Sanjosé, S., Kelly, H., Dalal, S., Eckert, L. O., Santesso, N., Broutet, N., & Canfell, K.
Affiliations
  • The University of Sydney (AU)
  • Hospital for Sick Children (CA)
  • Clinton Health Access Initiative (US)
  • Ghent University (BE)
  • Centre international de recherche sur le cancer (FR)
  • National Institutes of Health (US)
  • World Health Organization (CH)
  • London School of Hygiene & Tropical Medicine (GB)
  • University of Washington (US)
  • McMaster University (CA)
Corresponding author
Simms, Kate T.
Venue
Nature Medicine
Published
2023-12
Volume
29
Issue
12
Pages
3050-3058
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W4389617045
Cited by
105
References
67
Citations by year
2026: 29 · 2025: 43 · 2024: 32 · 2023: 1
FWCI
20.97
Type
journal article
Language
en
Open access
Locations
  • Nature Medicine (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Funders
World Health Organization
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
cervical cancer screening, HPV testing, cervical cancer elimination, cost-effectiveness, triage, visual inspection with acetic acid, colposcopy, cytology, low- and lower-middle-income countries, cervical cancer mortality
MeSH terms
Adult, Uterine Cervical Neoplasms, Cervix Uteri, Child, Preschool, Cost-Benefit Analysis, Female, Humans, Triage, Papillomavirus Infections, Early Detection of Cancer

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