Cervical screening

Raffle, Angela E.

doi:10.1136/bmj.328.7451.1272

Cited by 7 publications

(7 citation statements)

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“…A recent study discussed the poor use of cervical cancer screening resources within current NHS practice [49]. This change in sexual behaviour arises partly because of socio-economic changes through time and from place to place.…”

Section: Discussionmentioning

confidence: 99%

Elucidating the spatially varying relation between cervical cancer and socio-economic conditions in England

Cheng

Atkinson

Shahani

2011

International Journal of Health Geographics

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BackgroundGeographically weighted Poisson regression (GWPR) was applied to the relation between cervical cancer disease incidence rates in England and socio-economic deprivation, social status and family structure covariates. Local parameters were estimated which describe the spatial variation in the relations between incidence and socio-economic covariates.ResultsA global (stationary) regression model revealed a significant correlation between cervical cancer incidence rates and social status. However, a local (non-stationary) GWPR model provided a better fit with less spatial correlation (positive autocorrelation) in the residuals. Moreover, the GWPR model was able to represent local variation in the relations between cervical cancer incidence and socio-economic covariates across space, whereas the global model represented only the overall (or average) relation for the whole of England. The global model could lead to misinterpretation of the relations between cervical cancer incidence and socio-economic covariates locally.ConclusionsCervical cancer incidence was shown to have a non-stationary relationship with spatially varying covariates that are available through national datasets. As a result, it was shown that if low social status sectors of the population are to be targeted preferentially, this targeting should be done on a region-by-region basis such as to optimize health outcomes. While such a strategy may be difficult to implement in practice, the research does highlight the inequalities inherent in a uniform intervention approach.

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Section: Discussionmentioning

confidence: 99%

Elucidating the spatially varying relation between cervical cancer and socio-economic conditions in England

Cheng

Atkinson

Shahani

2011

International Journal of Health Geographics

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“…A computer-based probabilistic Markov model was constructed and analyzed with second order Monte Carlo simulations and was run from 32 years of age in 3-5 year cycles. The cycle length used is the same as the length of the screening intervals in the current program (ages [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] and was 5 years also after screening was finished (from age 50 to death). Women in the cohorts could remain in the same health state or move between states, as a result of being screened, tested, having treatment for CIN2-3 or dying from cervical cancer or other causes ( Fig.…”

Section: Methodsmentioning

confidence: 99%

“…[47][48][49] The extremely high negative predictive value of a negative combined cytology and HPV DNA test is supportive of stopping screening at age 50, particularly if there have been multiple negative combined tests before age 50. The incidence of carcinoma in situ decreases considerably after age 50.…”

Section: Discussionmentioning

confidence: 99%

“…37 Overall, previous reports and the results of our model support a policy of not screening women after age 50, if they have had multiple negative screening tests previously. 49,51 Adding HPV-DNA testing to cytology improves the negative predictive value from 96% to >99% and a double negative test confers an almost 100% assurance of not having CIN2-3 or invasive cancer, allowing an extension of the screening interval. 52 Screening frequency is primarily determined by the probability of a test being negative in a woman with disease and the average time required for a precursor to progress to invasive cancer.…”

Section: Discussionmentioning

confidence: 99%

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Cost‐effectiveness of primary cytology and HPV DNA cervical screening

Bistoletti

Sennfält

Dillner

2007

Intl Journal of Cancer

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Because cost-effectiveness of different cervical cytology screening strategies with and without human papillomavirus (HPV) DNA testing is unclear, we used a Markov model to estimate life expectancy and health care cost per woman during the remaining lifetime for 4 screening strategies: (i) cervical cytology screening at age 32, 35, 38, 41, 44, 47, 50, 55 and 60, (ii) same strategy with addition of testing for HPV DNA persistence at age 32, (iii) screening with combined cytology and testing for HPV DNA persistence at age 32, 41 and 50, iv) no screening. Input data were derived from population-based screening registries, health-service costs and from a population-based HPV screening trial. Impact of parameter uncertainty was addressed using probabilistic multivariate sensitivity analysis. Cytology screening between 32 and 60 years of age in 3-5 year intervals increased life expectancy and life-time costs were reduced from 533 to 248 US Dollars per woman compared to no screening. Addition of HPV DNA testing, at age 32 increased costs from 248 to 284 US Dollars without benefit on life expectancy. Screening with both cytology and HPV DNA testing, at ages 32, 41 and 50 reduced costs from 248 to 210 US Dollars with slightly increased life expectancy. In conclusion, population-based, organized cervical cytology screening between ages 32 to 60 is highly cost-efficient for cervical cancer prevention. If screening intervals are increased to at least 9 years, combined cytology and HPV DNA screening appeared to be still more effective and less costly. ' 2007 Wiley-Liss, Inc.Key words: Markov model; health economics; cervical cancer; organized screening Human Papillomavirus (HPV) DNA testing has been accepted as an adjunct to cytology for primary cervical screening in women over 30 years of age. 1,2 The combination of HPV testing and cervical cytology is more sensitive in detecting cervical intraepithelial neoplasia (CIN) lesions with risk for progression to invasive cancer than either method alone, with extremely high negative predictive values. [3][4][5] Several studies have evaluated the economic impact of cervical screening with and without HPV testing, but have reported variable results. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Possible reasons for discrepancies include different modeling methodologies, use of surrogate endpoints and use of input data based on clinical studies that may not have been representative of the population as a whole. However, most modeling studies have consistently found similar reductions of the cumulative lifetime risk of invasive cervical cancer as a result of cytology and HPV DNA screening. 6,11,12,19,[23][24][25] State transition models are used in more than 85% of all costeffectiveness analyses and several cervical cancer state transition models have been reported previously. 26,27 The long-term effects and cost of cytology and HPV screening cannot be captured in clinical trials, where all studies have used surrogate endpoints, such as CIN grade 2 or 3 (CIN2-3). ...

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“…The programme's age criteria have proved controversial (Sasieni at al. 2009;Sasieni et al 2003;Sasieni et al 2006;Rieck et al 2006;Raffle 2004). The age at which routine cervical screening should cease, including in particular whether it should be lowered to 50 years, has been much debated (Strander 2009;Rebolj et al 2009), but currently remains age 64.…”

Section: Introductionmentioning

confidence: 99%

Age Criteria for Cervical Screening in England: Qualitative Study of Women’s Views

Armstrong

Dixon‐Woods

Murphy³

2010

SSRN Journal

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The age criteria applied in the NHS Cervical Screening Programme have been much debated at policy and professional levels, but little is known about women's views on appropriate age criteria. Our objective is to provide insight into women's views on age criteria for the NHS Cervical Screening Programme in England. We present data collected as part of a qualitative interview study conducted in the East Midlands of England. Thirty-five women, representing a range of ages and ethnic groups, were interviewed. Analysis was based on the constant comparative method. Women's views about the age criteria that should appropriately be applied to cervical cancer screening diverged considerably from the technical principles and criteria upon which policy decisions are based. Women called for screening to be extended at both the upper and the lower ends of the age range. However, there was little explicit acknowledgement in women's accounts of the risks posed by screening or of the relative effectiveness and cost-effectiveness of screening in women of different ages. Policy decisions about screening programmes often face problems of legitimacy and acceptability. There is an increasingly pressing need to ensure that the criteria used to make decisions about who will be offered screening are made explicit and communicated effectively, so that people's views can be well-informed.3

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Cervical screening

Cited by 7 publications

References 5 publications

Elucidating the spatially varying relation between cervical cancer and socio-economic conditions in England

Elucidating the spatially varying relation between cervical cancer and socio-economic conditions in England

Cost‐effectiveness of primary cytology and HPV DNA cervical screening

Age Criteria for Cervical Screening in England: Qualitative Study of Women’s Views

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