Prediction of cervical cancer incidence in England, UK, up to 2040, under four scenarios: a modelling study

Abstract

SummaryBackgroundIn the next 25 years, the epidemiology of cervical cancer in England, UK, will change: human papillomavirus (HPV) screening will be the primary test for cervical cancer. Additionally, the proportion of women screened regularly is decreasing and women who received the HPV vaccine are due to attend screening for the first time. Therefore, we aimed to estimate how vaccination against HPV, changes to the screening test, and falling screening coverage will affect cervical cancer incidence in England up to 2040.MethodsWe did a data modelling study that combined results from population modelling of incidence trends, observable data from the individual level with use of a generalised linear model, and microsimulation of unobservable disease states. We estimated age-specific absolute risks of cervical cancer in the absence of screening (derived from individual level data). We used an age period cohort model to estimate birth cohort effects. We multiplied the absolute risks by the age cohort effects to provide absolute risks of cervical cancer for unscreened women in different birth cohorts. We obtained relative risks (RRs) of cervical cancer by screening history (never screened, regularly screened, or lapsed attender) using data from a population-based case-control study for unvaccinated women, and using a microsimulation model for vaccinated women. RRs of primary HPV screening were relative to cytology. We used the proportion of women in each 5-year age group (25–29 years to 75–79 years) and 5-year period (2016–20 to 2036–40) who have a combination of screening and vaccination history, and weighted to estimate the population incidence. The primary outcome was the number of cases and rates per 100 000 women under four scenarios: no changes to current screening coverage or vaccine uptake and HPV primary testing from 2019 (status quo), changing the year in which HPV primary testing is introduced, introduction of the nine-valent vaccine, and changes to cervical screening coverage.FindingsThe status quo scenario estimated that the peak age of cancer diagnosis will shift from the ages of 25–29 years in 2011–15 to 55–59 years in 2036–40. Unvaccinated women born between 1975 and 1990 were predicted to have a relatively high risk of cervical cancer throughout their lives. Introduction of primary HPV screening from 2019 could reduce age-standardised rates of cervical cancer at ages 25–64 years by 19%, from 15·1 in 2016 to 12·2 per 100 000 women as soon as 2028. Vaccination against HPV types 16 and 18 (HPV 16/18) could see cervical cancer rates in women aged 25–29 years decrease by 55% (from 20·9 in 2011–15 to 9·5 per 100 000 women by 2036–40), and introduction of nine-valent vaccination from 2019 compared with continuing vaccination against HPV 16/18 will reduce rates by a further 36% (from 9·5 to 6·1 per 100 000 women) by 2036–40. Women born before 1991 will not benefit directly from vaccination; therefore, despite vaccination and primary HPV screening with current screening coverage, European age-standardised ra...

The projected timeframe until cervical cancer elimination in Australia: a modelling study

“…31 We found that the annual age-standardised incidence of cervical cancer in Australia is predicted to plateau below a potential elimination threshold (at four cases per 100 000 women) if cohorts offered the nonavalent vaccine do not receive cervical screening. Our medium-term predictions for the incidence of cervical cancer are similar to estimates published for England, 32 which found that primary HPV screening and vaccination with the nonavalent vaccine (with screening coverage and vaccine uptake assumptions in women similar to those that we used in this analysis) is likely to reduce the annual age-standardised incidence of cervical cancer and the associated mortality rate in England by 28% in 2036-40 compared with estimates of incidence over the same time period in which cytology every 3 years and vaccination against only HPV types 16 and 18 were used. Our results are broadly consistant with this finding, since we found that scenarios that assumed a transition to the renewed NCSP showed an age-standardised incidence of cervical cancer that was 33% lower than if the pre-renewed NCSP had been maintained (as previously published).…”

Estimating the direct effect of human papillomavirus vaccination on the lifetime risk of screen‐detected cervical precancer

“…First, we assumed that there are no cohort effects. This may bias estimates of the absolute CIN3+ risk but the effect on the relative decline in risk is likely to be small 46 as we found little association between type distribution and age 47 . The absolute CIN3+ risk may be somewhat underestimated because recently the cervical cancer incidence has increased in the Netherlands, in particular in young women 48 .…”

Knowledge and attitudes toward cervical cancer, human papillomavirus (HPV), and HPV vaccination among women in Taizhou area, China

“…However, China still has a long way to go before cervical cancer is eliminated. In contrast to the reducing cervical cancer incidence and mortality trends in developed countries [4], a substantial increase in incidence and mortality was seen in China [2]. Multiple factors have been identified as contributors to the incidence of cervical cancer in developing regions of the world, such as lack of vaccines, lack of cervical screening programs, poor treatment services, and high HPV infection [5].…”