Reducing Overtreatment Associated with Overdiagnosis in Cervical Cancer Screening – A Model-based Benefit-Harm Analysis for Austria.
Authors of this article are:
Gaby S, Eva E, Andreas W, Wilhelm O, Wegene B, Dorothee VL, Monika H, Gottfried E, Uwe S,.
A summary of the article is shown below:
A general concern exists that cervical cancer screening using human papillomavirus (HPV) testing may lead to considerable overtreatment. We evaluated the trade-off between benefits and overtreatment among different screening strategies differing by primary tests (cytology, p16/Ki-67, HPV alone or in combinations), interval, age, and diagnostic follow-up algorithms. A Markov state-transition model calibrated to the Austrian epidemiological context was used to predict cervical cancer cases, deaths, overtreatments, and incremental harm-benefit ratios (IHBR) for each strategy. When considering the same screening interval, HPV-based screening strategies were more effective compared with cytology or p16/Ki-67 testing (e.g., relative reduction in cervical cancer with biennial screening: 67.7% for HPV+Pap co-testing, 57.3% for cytology, and 65.5% for p16/Ki-67), but were associated with increased overtreatment (e.g. 19.8% more conizations with biennial HPV+Pap-cotesting vs. biennial cytology). The IHBRs measured in unnecessary conizations per additional prevented cancer-related death were 31 (quinquennial Pap+p16/Ki-67-triage), 49 (triennial Pap+p16/Ki-67-triage), 58 (triennial HPV+Pap co-testing), 66 (biennial HPV+Pap co-testing), 189 (annual Pap+p16/Ki-67-triage), and 401 (annual p16/Ki-67 testing alone). The IHBRs increased significantly with increasing screening adherence rates and slightly with lower age at screening initiation, with a reduction in HPV incidence or with lower Pap-test sensitivity. Depending on the accepted IHBR threshold, biennial or triennial HPV-based screening in women as of age 30 and biennial cytology in younger women may be considered in opportunistic screening settings with low or moderate adherence such as in Austria. In organized settings with high screening adherence and in post-vaccination settings with lower HPV prevalence, the interval may be prolonged. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.
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This article is a good source of information and a good way to become familiar with topics such as: Human papillomavirus; Papanicolaou; benefit-harm analysis; cervical cancer; decision analysis; p16/Ki-67; screening.
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