Shift in harms and benefits of cervical cancer screening in the era of HPV screening and vaccination: a modelling study

Abstract

Objective: To calculate the changes in harms and benefits of cervical cancer screening over the first three screening rounds of the Dutch high-risk human papillomavirus (hrHPV) screening programme.

Design: Microsimulation study.

Setting: Dutch hrHPV screening programme; women are invited for screening every 5 or 10 years (depending on age and screening history) from age 30 to 65.

Population: Partly vaccinated population of 100 million Dutch women.

Methods: Microsimulation model MISCAN was used to estimate screening effects. Sensitivity analyses were performed on test characteristics and attendance.

Main outcome measures: Harms (screening tests, unnecessary referrals, treatment-related health problems), benefits (CIN2⁺ diagnoses) and programme efficiency (number needed to screen [NNS]) over the first (period 2017-2021), second (period 2022-2026) and third (period 2027-2031) rounds of hrHPV-based screening.

Results: The number of screening tests and CIN2⁺ diagnoses decreased from the first to the second round (-25.8% and -23.6%, respectively). In the third screening round, these numbers decreased further, albeit only slightly (-2.7% and -5.3%, respectively). NNS to detect a CIN2⁺ remained constant over the rounds; however, it increased in younger age groups while decreasing in older age groups.

Conclusion: Both harms and benefits of hrHPV screening decreased over the first screening rounds. For younger women, the efficiency would decrease, whereas longer screening intervals would lead to increased efficiency in older women. Programme efficiency overall remained stable, showing the importance of longer intervals for low-risk women.

Tweetable abstract: Cervical cancer screening: both harms and benefits of hrHPV screening will decrease in the future.

Keywords: HPV screening; cervical cancer screening; modelling study.