Screening for Cervical Cancer in Primary Care: A Decision Analysis for the US Preventive Services Task Force.

JAMA : the Journal of the American Medical Association
Jane J KimStephen Sy

Abstract

Evidence on the relative benefits and harms of primary high-risk human papillomavirus (hrHPV) testing is needed to inform guidelines. To inform the US Preventive Services Task Force by modeling the benefits and harms of various cervical cancer screening strategies. Microsimulation model of a hypothetical cohort of women initiating screening at age 21 years. Screening with cytology, hrHPV testing, and cytology and hrHPV cotesting, varying age to switch from cytology to hrHPV testing or cotesting (25, 27, 30 years), rescreening interval (3, 5 years), and triage options for hrHPV-positive results (16/18 genotype, cytology testing). Current guidelines-based screening strategies comprised cytology alone every 3 years starting at age 21 years, with or without a switch to cytology and hrHPV cotesting every 5 years from ages 30 to 65 years. Complete adherence for all 19 strategies was assumed. Lifetime number of tests, colposcopies, disease detection, false-positive results, cancer cases and deaths, life-years, and efficiency ratios expressing the trade-off of harms (ie, colposcopies, tests) vs benefits (life-years gained, cancer cases averted). Efficient strategies were those that yielded more benefit and less harm than another strate...Continue Reading

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Citations

May 17, 2019·Journal of Pathology and Translational Medicine·Sung-Chul Lim, Chong Woo Yoo
Jul 16, 2019·Clinical Obstetrics and Gynecology·Ama Bus-KwofieKevin Holcomb
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