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Projected future impact of HPV vaccination and primary HPV screening on cervical cancer rates from 2017-2035: Example from Australia

Affiliations

• ¹ Cancer Research Division, Cancer Council NSW, Sydney, Australia.
• ² School of Public Health, University of Sydney, Sydney, Australia.
• ³ Victorian Cytology Service Ltd., Melbourne, Australia.
• ⁴ Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.

• PMID: 29444073
• PMCID: PMC5812553
• DOI: 10.1371/journal.pone.0185332

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Michaela T Hall et al. PLoS One. 2018.

• ¹ Cancer Research Division, Cancer Council NSW, Sydney, Australia.
• ² School of Public Health, University of Sydney, Sydney, Australia.
• ³ Victorian Cytology Service Ltd., Melbourne, Australia.
• ⁴ Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.

• PMID: 29444073
• PMCID: PMC5812553
• DOI: 10.1371/journal.pone.0185332

Item in Clipboard

Background: Many countries are transitioning from cytology-based to longer-interval HPV screening. Trials comparing HPV-based screening to cytology report an increase in CIN2/3 detection at the first screen, and longer-term reductions in CIN3+; however, population level year-to-year transitional impacts are poorly understood. We undertook a comprehensive evaluation of switching to longer-interval primary HPV screening in the context of HPV vaccination. We used Australia as an example setting, since Australia will make this transition in December 2017.

Methods: Using a model of HPV vaccination, transmission, natural history and cervical screening, Policy1-Cervix, we simulated the planned transition from recommending cytology every two years for sexually-active women aged 18-20 to 69, to recommending HPV screening every five years for women aged 25-74 years. We estimated rates of CIN2/3, cervical cancer incidence, and mortality for each year from 2005 to 2035, considering ranges for HPV test accuracy and screening compliance in the context of HPV vaccination (current coverage ~82% in females; ~76% in males).

Findings: Transient increases are predicted to occur in rates of CIN2/3 detection and invasive cervical cancer in the first two to three years following the screening transition (of 16-24% and 11-14% in respectively, compared to 2017 rates). However, by 2035, CIN2/3 and invasive cervical cancer rates are predicted to fall by 40-44% and 42-51%, respectively, compared to 2017 rates. Cervical cancer mortality rates are predicted to remain unchanged until ~2020, then decline by 34-45% by 2035. Over the period 2018-2035, switching to primary HPV screening in Australia is expected to avert 2,006 cases of invasive cervical cancer and save 587 lives.

Conclusions: Transient increases in detected CIN2/3 and invasive cancer, which may be detectable at the population level, are predicted following a change to primary HPV screening. This is due to improved test sensitivity bringing forward diagnoses, resulting in longer term reductions in both cervical cancer incidence and mortality. Fluctuations in health outcomes due to the transition to a longer screening interval are predicted to occur for 10-15 years, but cervical cancer rates will be significantly reduced thereafter due to the impact of HPV vaccination and HPV screening. In order to maintain confidence in primary HPV screening through the transitional phase, it is important to widely communicate that an initial increase in CIN2/3 and perhaps even invasive cervical cancer is expected after a national transition to primary HPV screening, that this phenomenon is due to increased prevalent disease detection, and that this effect represents a marker of screening success.

PubMed Disclaimer

Competing Interests: Karen Canfell and Marion Saville are both co-PI’s of an investigator-initiated trial of cytology and primary HPV screening in Australia (‘Compass’) (ACTRN12613001207707 and NCT02328872), which is conducted and funded by the Victorian Cytology Service (VCS) Inc Ltd., a government-funded health promotion charity. The VCS Inc Ltd. have received equipment and a funding contribution for the Compass trial from Roche Molecular Systems and Ventana Inc USA. KC and Marion Saville are CI’s on Compass in New Zealand, (‘Compass NZ’) (ACTRN12614000714684) which is conducted and funded by Diagnostic Medlab, now Auckland District Health Board. DML received an equipment and a funding contribution for the Compass trial from Roche Molecular Systems. However neither KC, nor her institution on her behalf (Cancer Council NSW) receive direct or indirect funding from industry for Compass Australia or NZ or any other project. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

*Ages considered are 0–84 years; age standardised rates are standardised to the Australian Bureau of Statistics 2001 ‘Series B’ population estimates.

*Ages considered are 0–84 years; age standardised rates are standardised to the Australian Bureau of Statistics 2001 ‘Series B’ population estimates.

*Ages considered are 0–84 years; age standardised rates are standardised using the Australian 2001 Standard Population; case numbers are calculated using the Australian Bureau of Statistics ‘Series B’ population estimates.

*Ages considered are 0–84 years; age standardised rates are standardised using the Australian 2001 Standard Population; case numbers are calculated using the Australian Bureau of Statistics ‘Series B’ population estimates.

* Cumulative lifetime risk is calculated to age 84 years.

• The combined impact of implementing HPV immunisation and primary HPV screening in New Zealand: Transitional and long-term benefits, costs and resource utilisation implications.

  Hall MT, Smith MA, Lew JB, O'Hallahan J, Fentiman G, Neal H, Sage M, Canfell K. Hall MT, et al. Gynecol Oncol. 2019 Mar;152(3):472-479. doi: 10.1016/j.ygyno.2018.10.045. Gynecol Oncol. 2019. PMID: 30876491

• The projected timeframe until cervical cancer elimination in Australia: a modelling study.

  Hall MT, Simms KT, Lew JB, Smith MA, Brotherton JM, Saville M, Frazer IH, Canfell K. Hall MT, et al. Lancet Public Health. 2019 Jan;4(1):e19-e27. doi: 10.1016/S2468-2667(18)30183-X. Epub 2018 Oct 2. Lancet Public Health. 2019. PMID: 30291040

• How will transitioning from cytology to HPV testing change the balance between the benefits and harms of cervical cancer screening? Estimates of the impact on cervical cancer, treatment rates and adverse obstetric outcomes in Australia, a high vaccination coverage country.

  Velentzis LS, Caruana M, Simms KT, Lew JB, Shi JF, Saville M, Smith MA, Lord SJ, Tan J, Bateson D, Quinn M, Canfell K. Velentzis LS, et al. Int J Cancer. 2017 Dec 15;141(12):2410-2422. doi: 10.1002/ijc.30926. Epub 2017 Oct 5. Int J Cancer. 2017. PMID: 28801947

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• Overview of human papillomavirus-based and other novel options for cervical cancer screening in developed and developing countries.

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• Evaluation of Urine and Vaginal Self-Sampling versus Clinician-Based Sampling for Cervical Cancer Screening: A Field Comparison of the Acceptability of Three Sampling Tests in a Rural Community of Cuenca, Ecuador.

  Vega Crespo B, Neira VA, Ortíz S J, Maldonado-Rengel R, López D, Gómez A, Vicuña MJ, Mejía J, Benoy I, Carreño TP, Verhoeven V. Vega Crespo B, et al. Healthcare (Basel). 2022 Aug 25;10(9):1614. doi: 10.3390/healthcare10091614. Healthcare (Basel). 2022. PMID: 36141226 Free PMC article.

• Individual and intimate-partner factors associated with cervical cancer screening in Central Uganda.

  Isabirye A. Isabirye A. PLoS One. 2022 Sep 15;17(9):e0274602. doi: 10.1371/journal.pone.0274602. eCollection 2022. PLoS One. 2022. PMID: 36108074 Free PMC article.

• Prevalence of Vaccine Type Infections in Vaccinated and Non-Vaccinated Young Women: HPV-IMPACT, a Self-Sampling Study.

  Jeannot E, Viviano M, de Pree C, Amadane M, Kabengele E, Vassilakos P, Petignat P. Jeannot E, et al. Int J Environ Res Public Health. 2018 Jul 9;15(7):1447. doi: 10.3390/ijerph15071447. Int J Environ Res Public Health. 2018. PMID: 29987255 Free PMC article.

• Implementation of Australia's renewed cervical screening program: Preparedness of general practitioners and nurses.

  Sultana F, Roeske L, Malloy MJ, McDermott TL, Saville M, Brotherton JML. Sultana F, et al. PLoS One. 2020 Jan 29;15(1):e0228042. doi: 10.1371/journal.pone.0228042. eCollection 2020. PLoS One. 2020. PMID: 31995585 Free PMC article.

• Benefits, harms and cost-effectiveness of cervical screening, triage and treatment strategies for women in the general population.

  Simms KT, Keane A, Nguyen DTN, Caruana M, Hall MT, Lui G, Gauvreau C, Demke O, Arbyn M, Basu P, Wentzensen N, Lauby-Secretan B, Ilbawi A, Hutubessy R, Almonte M, De Sanjosé S, Kelly H, Dalal S, Eckert LO, Santesso N, Broutet N, Canfell K. Simms KT, et al. Nat Med. 2023 Dec;29(12):3050-3058. doi: 10.1038/s41591-023-02600-4. Epub 2023 Dec 12. Nat Med. 2023. PMID: 38087115 Free PMC article.

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