Pathways to a cancer-free future: A protocol for modelled evaluations to maximize the future impact of interventions on cervical cancer in Australia

Velentzis, Louiza S; Smith, Megan A.; Simms, Kate T.; Lew, Jie-Bin; Hall, Michaela; Hughes, Suzanne; Yuill, Susan; Killen, James; Keane, Adam; Butler, Katherine; Darlington-Brown, Jessica; Hui, Harriet; Brotherton, Julia; Skinner, S. Rachel; Brand, Alison; Roeske, Lara; Heley, Stella; Carter, Jonathan; Bateson, Deborah; Frazer, Ian H.; Garland, Suzanne M.; Guy, Rebecca; Hammond, Ian; Grogan, Paul; Arbyn, Marc; Castle, Philip E.; Saville, Marion; Armstrong, Bruce K.; Canfell, Karen

doi:10.1016/j.ygyno.2018.12.019

Cited by 11 publications

(4 citation statements)

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“…Pathways as an overarching programme was previously described. 16 Since that time, Pathways has changed from a staged approach to a more iterative process. As modelled evaluation results become available, they are immediately reviewed and disseminated as appropriate to support potential policy change.…”

Section: Methods and Analysis Study Designmentioning

confidence: 99%

“…It aims to identify the best-value investments, or 'best buys', in cancer control to inform future decision making. First described in relation to cervical cancer, 16 the Pathways model is now being applied to five major cancerscervical, lung, colorectal, prostate and breast cancer-and to cancers relating to Lynch syndrome, and early work has commenced in melanoma and cancers of the ovary and liver. Pathways-Bowel refers to the programme focused on CRC, with a detailed assessment of high-risk individuals with Lynch syndrome and other Lynch-related cancers incorporating evidence-based intervention implementation currently under way, 17 18 as part of Pathways-Lynch.…”

Section: Introduction Backgroundmentioning

confidence: 99%

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Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia

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IntroductionWith almost 50% of cases preventable and the Australian National Bowel Cancer Screening Program in place, colorectal cancer (CRC) is a prime candidate for investment to reduce the cancer burden. The challenge is determining effective ways to reduce morbidity and mortality and their implementation through policy and practice. Pathways-Bowel is a multistage programme that aims to identify best-value investment in CRC control by integrating expert and end-user engagement; relevant evidence; modelled interventions to guide future investment; and policy-driven implementation of interventions using evidence-based methods.Methods and analysisPathways-Bowel is an iterative work programme incorporating a calibrated and validated CRC natural history model for Australia (Policy1-Bowel) and assessing the health and cost outcomes and resource use of targeted interventions. Experts help identify and prioritise modelled evaluations of changing trends and interventions and critically assess results to advise on their real-world applicability. Where appropriate the results are used to support public policy change and make the case for optimal investment in specific CRC control interventions. Fourteen high-priority evaluations have been modelled or planned, including evaluations of CRC outcomes from the changing prevalence of modifiable exposures, including smoking and body fatness; potential benefits of daily aspirin intake as chemoprevention; increasing CRC incidence in people aged <50 years; increasing screening participation in the general and Aboriginal and Torres Strait Islander populations; alternative screening technologies and modalities; and changes to follow-up surveillance protocols. Pathways-Bowel is a unique, comprehensive approach to evaluating CRC control; no prior body of work has assessed the relative benefits of a variety of interventions across CRC development and progression to produce a list of best-value investments.Ethics and disseminationEthics approval was not required as human participants were not involved. Findings are reported in a series of papers in peer-reviewed journals and presented at fora to engage the community and policymakers.

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Section: Methods and Analysis Study Designmentioning

confidence: 99%

Section: Introduction Backgroundmentioning

confidence: 99%

Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia

et al. 2020

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“…However, coverage has been partially restored in Ireland after a well-coordinated campaign to address the issues. Longer term, countries should consider investments into ongoing information campaigns to provide parents with the evidence on vaccine safety; ongoing work is considering the cost-effectiveness of such proactive investment [8].…”

Section: Introductionmentioning

confidence: 99%

Towards the global elimination of cervical cancer

Canfell

2019

Papillomavirus Research

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Two very effective prevention strategies for cervical cancer exist – vaccination against the human papillomavirus (HPV) and cervical screening with primary HPV testing followed by treatment of precancerous lesions. In 2018, the World Health Organisation called for action towards achieving the global elimination of cervical cancer, and a strategic plan encompassing elimination goals and targets for the scale-up of HPV vaccination, cervical screening and precancer and cancer treatment, particularly in low and middle income countries, will be presented to the 2020 World Health Assembly. The first published estimates suggest that achieving rapid scale-up of both vaccination and twice lifetime cervical screening in all countries would avert up to 13.4 million cervical cancer cases over the next half century, with the majority (but not all) countries achieving incidence of <4 per 100,000 women by 2100. However, there are significant challenges - (i) including vaccine manufacturing pipeline, supply, delivery and hesitancy, (ii) cervical screening HPV self-collection and point-of-care evaluation, acceptability, and scaling up effective precancer treatment processes, (iii) configuration of appropriate referral pathways, cancer treatment services and palliative care for those women who do develop cervical cancer, as well as (iv) the effective financing of both HPV vaccination and cervical screening on a large scale. It is hoped and anticipated that the WHO elimination initiative will galvanise concerted action to address these issues.

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“…We ultimately need to move to personalised screening schedules for each person at risk of these cancers according to algorithms that incorporate personal history (including lifestyle factors), the initial screening findings, and genetic factors. Micro‐simulation modelling offers a new approach to planning risk‐stratified, population‐level screening by incorporating all risk elements . The ability to balance risks and benefits at this level of detail is the ultimate goal for population screening, but is not in sight yet for most cancers.…”

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Renewed cervical screening: what the early results tell us

Currow

Aranda

2019

Medical Journal of Australia

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mja2.50267 ▪ See Research (Machalek).The renewed program delivers a more personalised program for women by applying risk stratification A n estimated 570 000 women were diagnosed with cervical cancer in 2018, and its incidence and mortality are particularly high in low and middle income countries. 1 In Australia, the incidence of cervical cancer has plummeted since the national screening program was introduced in the early 1990s. 2 More recently, the national human papillomavirus (HPV) vaccination program for teenage girls and boys was followed by a reduction in the proportion of women with high grade dysplasia and an increase in the age at which such pathology is detected, 3 reflecting the positive health impacts of the program. The elimination of cervical cancer as a public health problem and the associated premature mortality is an exciting but realistic prospect. 4It is 51 years since the World Health Organization (WHO) adopted criteria for population screening programs. 5 That these criteria remain valid after more than half a century is in itself remarkable, and they can still be applied even as our understanding of the pathophysiology of cervical cancer evolves and the technology for screening improves. Generating an acceptable test for detecting pre-invasive lesions, thereby improving survival for women with screen-detected cancers, is the crux of population screening.The new national cervical screening program reflects an important shift in population-based screening in Australia, identifying women at risk of developing pre-invasive lesions with HPV DNA screening. This risk-based approach offers the opportunity to tailor the timing of subsequent screening. The study reported by Machalek and colleagues in this issue of the MJA 6 helps reaffirm that the shift to the more sensitive HPV DNA test and a risk-based management algorithm is supported by the different rates of cervical abnormality associated with specific oncogenic strains of HPV. This personalisation of risk assessment builds on the more limited risk stratification (based solely on age) in the current national breast and bowel screening programs and the earlier cervical screening program.In Australia, there are still marked disparities in the incidence and mortality of cervical cancer in different communities: 5-year survival among Aboriginal and Torres Strait Islander Australians is lower than for other women (54% v 70%), and for the most socioeconomically disadvantaged women the incidence of cervical cancer is higher (9.1 v 6.0 cases per 100 000 women) and 5-year survival lower (61% v 79%) than for the least disadvantaged. 2 Assessing outcomes for these communities is difficult on the basis of the demographic data collected by the cervical cancer program, but we know even less about those for women from diverse cultural backgrounds, women who have experienced sexual assault or domestic violence, and women in the LGBTQI community.The acceptability of Pap tests was a challenge for the previous national screening program. According to the 1968 WHO...

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Pathways to a cancer-free future: A protocol for modelled evaluations to maximize the future impact of interventions on cervical cancer in Australia

Cited by 11 publications

References 28 publications

Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia

Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia

Towards the global elimination of cervical cancer

Renewed cervical screening: what the early results tell us

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