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Modeling the impact of screening policy and screening compliance on incidence and mortality of cervical cancer in the post-HPV vaccination era

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JournalJournal of public health
DatePublished - Dec 2012
Issue number4
Volume34
Number of pages9
Pages (from-to)539-547
Original languageEnglish

Abstract

Background In Norway, pap smear screening target women aged 2569 years on a triennial basis. The introduction of human papillomavirus (HPV) mass immunization in 2009 raises questions regarding the cost-saving future changes to current screening strategies.

Methods We calibrated a dynamic HPV transmission model to Norwegian data and assessed the impact of changing screening 20 or 30 years after vaccine introduction, assuming 60 or 90 vaccination coverage. Screening compliance among vaccinated women was assumed at 80 or 50. Strategies considered: (i) 5-yearly screening of women of 2569 years, (ii) 3-yearly screening of women of 3069 years and (iii) 3-yearly screening of women of 2559 years.

Results Greatest health gains were accomplished by ensuring a high vaccine uptake. In 2060, cervical cancer incidence was reduced by an estimated 3657 compared with that of no vaccination. Stopping screening at the age of 60 years, excluding opportunistic screening, increased cervical cancer incidence by 3 (2060) compared with maintaining the current screening strategy, resulting in 1.02.4 extra cancers (20102060). The 5-yearly screening strategy elevated cervical cancer incidence by 30 resulting in 4.711.3 additional cancers.

Conclusion High vaccine uptake in the years to come is of primary concern. Screening of young women 30 years remains important, even under the conditions of high vaccine coverage.

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