Invited Commentary: Rethinking Cervical Cancer Elimination in Terms of Lifetime Risk Rather Than Arbitrarily Defined Age-Standardized Incidence Rates

Abstract

In their accompanying article, Vänskä et al. (Am J Epidemiol. 2021;190(4):506-514) provide us with cohort lifetime risks of cervical cancer attributable to different types of human papillomavirus in Sweden. We argue that a standardized lifetime risk such as those calculated by Vänskä et al. might be a more appropriate public health target for cervical cancer elimination than age-standardized incidence rates. Age standardization to an arbitrary standard age distribution implies an implicit value choice regarding the weight of different age groups for which we find little moral justification. Conversely, a standardized lifetime risk uses standard life expectancy as a weight, corresponding to the likelihood that cervical cancer would impact a woman and prevent her from pursuing opportunities within a standard life span. Based on the data from Vänskä et al., a standardized lifetime risk of 129-250 cervical cancers per 100,000 women born could be an aspirational alternative public health target for cervical cancer elimination as a public health problem, complementary to the World Health Organization's arbitrary draft target of 4 cervical cancers per 100,000 age-standardized woman-years.