What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study

Landy, Rebecca; Windridge, Peter; Gillman, Matthew; Sasieni, Peter

doi:10.1002/ijc.31094

Cited by 55 publications

(52 citation statements)

References 27 publications

(46 reference statements)

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“…The effect of screening in vaccinated women was estimated from a microsimulation model 8 ( appendix pp 4–7 ). Vaccinated women in the model are offered screening with use of HPV testing with a 6-year interval.…”

Section: Methodsmentioning

confidence: 99%

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

Castañón

Landy

Pesola

et al. 2018

The Lancet Public Health

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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...

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Section: Methodsmentioning

confidence: 99%

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

Castañón

Landy

Pesola

et al. 2018

The Lancet Public Health

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“…Future screening guidelines will need to consider vaccine uptake and the prevalence of HPV infection. Dependent on the local context, there may be interest in personalizing screening based on vaccination status [49].…”

Section: Prophylactic Hpv Vaccinationmentioning

confidence: 99%

Screening for the Prevention and Early Detection of Cervical Cancer: Protocol for Systematic Reviews to Inform Canadian Recommendations

Gates

Pillay

Reynolds

et al. 2020

Preprint

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Purpose. To inform recommendations by the Canadian Task Force on Preventive Health Care on screening in primary care for the prevention and early detection of cervical cancer by systematically reviewing evidence of: (a) effectiveness; (b) test accuracy; (c) individuals’ values and preferences, and (d) strategies aimed at improving screening rates.Methods. De novo reviews will be conducted to evaluate effectiveness and to assess values and preferences. For test accuracy and strategies to improve screening rates, we will integrate studies from existing systematic reviews with search updates to the present. Two Cochrane reviews will provide evidence of adverse pregnancy outcomes from the conservative management of cervical intraepithelial neoplasia. We will search Medline, Embase, and Cochrane Central (except for individuals’ values and preferences, where Medline, Scopus, and EconLit will be searched) via peer-reviewed search strategies, and the reference lists of included studies and reviews. We will search ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. Two reviewers will screen potentially eligible studies and agree on those to include. Data will be extracted by one reviewer with verification by another. Two reviewers will independently assess risk of bias and reach consensus. Where possible and suitable, we will pool studies via meta-analysis. We will compare accuracy data per outcome and per comparison using the Rutter and Gatsonis hierarchical summary receiver operating characteristic model and report relative sensitivities and specificities. Findings on values and preferences will be synthesized using a narrative synthesis approach and thematic analysis, depending on study designs. Two reviewers will appraise the certainty of evidence for all outcomes using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and come to consensus.Discussion. The publication of guidance on screening in primary care for the prevention and early detection of cervical cancer by the Task Force in 2013 focused on cytology. Since 2013, new studies using human papillomavirus tests for cervical screening have been published that will improve our understanding of screening in primary care settings. This review will inform updated recommendations based on currently available studies and address key evidence gaps noted in our previous review.Systematic review registration: not registered.

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Section: Prophylactic Hpv Vaccinationmentioning

confidence: 99%

Screening for Cervical Cancer: Protocol for Systematic Reviews to Inform Canadian Recommendations

Gates

Pillay

Reynolds

et al. 2020

Preprint

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Abstract Purpose. To inform recommendations by the Canadian Task Force on Preventive Health Care on cervical cancer screening by systematically reviewing evidence of: (a) the effectiveness; (b) test accuracy; (c) individuals’ values and preferences, and (d) strategies aimed at improving screening rates.Methods. De novo reviews will be conducted to evaluate effectiveness and to assess values and preferences. For test accuracy and strategies to improve screening rates, we will integrate studies from existing systematic reviews with search updates to the present. Two Cochrane reviews will provide evidence of adverse pregnancy outcomes from the conservative management of cervical intraepithelial neoplasia. We will search Medline, Embase, and Cochrane Central (except for individuals’ values and preferences, where Medline, Scopus, and EconLit will be searched) via peer-reviewed search strategies, and the reference lists of included studies and reviews. We will search ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. Two reviewers will screen potentially eligible studies and agree on those to include. Data will be extracted by one reviewer with verification by another. Two reviewers will independently assess risk of bias and reach consensus. Where possible and suitable, we will pool studies via meta-analysis. We will compare accuracy data per outcome and per comparison using the Rutter and Gatsonis hierarchical summary receiver operating characteristic model and report relative sensitivities and specificities. Findings on values and preferences will be synthesized using a narrative synthesis approach and thematic analysis, depending on study designs. Two reviewers will appraise the certainty of evidence for all outcomes using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and come to consensus.Discussion. The publication of guidance on cervical cancer screening by the Task Force in 2013 focused on cytology. Since 2013, new studies using human papillomavirus tests for detection of cervical cancer have been published that will improve our understanding of screening in primary care settings. This review will inform updated recommendations based on currently available studies and address key evidence gaps noted in our previous review.Systematic review registration: not registered.

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What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study

Cited by 55 publications

References 27 publications

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

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

Screening for the Prevention and Early Detection of Cervical Cancer: Protocol for Systematic Reviews to Inform Canadian Recommendations

Screening for Cervical Cancer: Protocol for Systematic Reviews to Inform Canadian Recommendations

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