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

Women vaccinated against HPV16/18 are approaching the age for cervical screening; however, an updated screening algorithm has not been agreed. We use a microsimulation model calibrated to real published data to determine the appropriate screening intensity for vaccinated women. Natural histories in...

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Autores principales: Landy, Rebecca, Windridge, Peter, Gillman, Matthew S., Sasieni, Peter D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765470/
https://www.ncbi.nlm.nih.gov/pubmed/29023748
http://dx.doi.org/10.1002/ijc.31094
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author Landy, Rebecca
Windridge, Peter
Gillman, Matthew S.
Sasieni, Peter D.
author_facet Landy, Rebecca
Windridge, Peter
Gillman, Matthew S.
Sasieni, Peter D.
author_sort Landy, Rebecca
collection PubMed
description Women vaccinated against HPV16/18 are approaching the age for cervical screening; however, an updated screening algorithm has not been agreed. We use a microsimulation model calibrated to real published data to determine the appropriate screening intensity for vaccinated women. Natural histories in the absence of vaccination were simulated for 300,000 women using 10,000 sets of transition probabilities. Vaccination with (i) 100% efficacy against HPV16/18, (ii) 15% cross‐protection, (iii) 22% cross‐protection, (iv) waning vaccine efficacy and (v) 100% efficacy against HPV16/18/31/33/45/52/58 was added, as were a range of screening scenarios appropriate to the UK. To benchmark cost‐benefits of screening for vaccinated women, we evaluated the proportion of cancers prevented per additional screen (incremental benefit) of current cytology and likely HPV screening scenarios in unvaccinated women. Slightly more cancers are prevented through vaccination with no screening (70.3%, 95% CR: 65.1–75.5) than realistic compliance to the current UK screening programme in the absence of vaccination (64.3%, 95% CR: 61.3–66.8). In unvaccinated women, when switching to HPV primary testing, there is no loss in effectiveness when doubling the screening interval. Benchmarking supports screening scenarios with incremental benefits of ≥2.0%, and rejects scenarios with incremental benefits ≤0.9%. In HPV16/18‐vaccinated women, the incremental benefit of offering a third lifetime screen was at most 3.3% (95% CR: 2.2–4.5), with an incremental benefit of 1.3% (−0.3–2.8) for a fourth screen. For HPV16/18/31/33/45/52/58‐vaccinated women, two lifetime screens are supported. It is important to know women's vaccination status; in these simulations, HPV16/18‐vaccinated women require three lifetime screens, HPV16/18/31/33/45/52/58‐vaccinated women require two lifetime screens, yet unvaccinated women require seven lifetime screens.
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spelling pubmed-57654702018-02-01 What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study Landy, Rebecca Windridge, Peter Gillman, Matthew S. Sasieni, Peter D. Int J Cancer Cancer Epidemiology Women vaccinated against HPV16/18 are approaching the age for cervical screening; however, an updated screening algorithm has not been agreed. We use a microsimulation model calibrated to real published data to determine the appropriate screening intensity for vaccinated women. Natural histories in the absence of vaccination were simulated for 300,000 women using 10,000 sets of transition probabilities. Vaccination with (i) 100% efficacy against HPV16/18, (ii) 15% cross‐protection, (iii) 22% cross‐protection, (iv) waning vaccine efficacy and (v) 100% efficacy against HPV16/18/31/33/45/52/58 was added, as were a range of screening scenarios appropriate to the UK. To benchmark cost‐benefits of screening for vaccinated women, we evaluated the proportion of cancers prevented per additional screen (incremental benefit) of current cytology and likely HPV screening scenarios in unvaccinated women. Slightly more cancers are prevented through vaccination with no screening (70.3%, 95% CR: 65.1–75.5) than realistic compliance to the current UK screening programme in the absence of vaccination (64.3%, 95% CR: 61.3–66.8). In unvaccinated women, when switching to HPV primary testing, there is no loss in effectiveness when doubling the screening interval. Benchmarking supports screening scenarios with incremental benefits of ≥2.0%, and rejects scenarios with incremental benefits ≤0.9%. In HPV16/18‐vaccinated women, the incremental benefit of offering a third lifetime screen was at most 3.3% (95% CR: 2.2–4.5), with an incremental benefit of 1.3% (−0.3–2.8) for a fourth screen. For HPV16/18/31/33/45/52/58‐vaccinated women, two lifetime screens are supported. It is important to know women's vaccination status; in these simulations, HPV16/18‐vaccinated women require three lifetime screens, HPV16/18/31/33/45/52/58‐vaccinated women require two lifetime screens, yet unvaccinated women require seven lifetime screens. John Wiley and Sons Inc. 2017-11-10 2018-02-15 /pmc/articles/PMC5765470/ /pubmed/29023748 http://dx.doi.org/10.1002/ijc.31094 Text en © 2017 The Authors International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC This is an open access article under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Cancer Epidemiology
Landy, Rebecca
Windridge, Peter
Gillman, Matthew S.
Sasieni, Peter D.
What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study
title What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study
title_full What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study
title_fullStr What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study
title_full_unstemmed What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study
title_short What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study
title_sort what cervical screening is appropriate for women who have been vaccinated against high risk hpv? a simulation study
topic Cancer Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765470/
https://www.ncbi.nlm.nih.gov/pubmed/29023748
http://dx.doi.org/10.1002/ijc.31094
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