Objectives: In 2017, the National Cervical Screening Program in Australia will transition to 5-yearly primary HPV screening for all women, irrespective of human papillomavirus (HPV) vaccination status. As an adjunct to the mainstream program, HPV testing on self-collected samples will be offered under practitioner supervision to all unscreened and underscreened women aged 30–74 years. We quantified how different screening decisions affect the future risk of cervical cancer.
Design: Simulation of outcomes for 100 000 previously unscreened women, aged 30 years and eligible for self-collection, using a well-established model of HPV natural history and cervical screening.
Main outcome measures: Cumulative cancer diagnoses and deaths averted (compared with remaining unscreened) to age 84, number needed to treat for pre-cancer (NNT) to avert each cancer diagnosis.
Results: One round of self-collected HPV screening at age 30 years would avert 908 cancer diagnoses and 364 cancer deaths in the cohort by age 84 (NNT, 5.8). Benefits would still be achieved were self-collected screening delayed to age 40 (922 fewer diagnoses; 426 fewer deaths; NNT, 3.7) or 50 (684 fewer diagnoses; 385 fewer deaths; NNT, 3.2). However, the benefits associated with joining the mainstream screening program would be substantially larger (2002, 1623 or 1091 fewer diagnoses and NNT of 4.9, 3.7 or 3.4 by joining at age 30, 40 or 50 years respectively). The relative benefits of joining the mainstream program were similar for cohorts who had been offered vaccination.
Conclusions: Offering HPV self-collection has the potential to considerably improve outcomes for unscreened and underscreened women. Nevertheless, these findings underscore the need for concerted strategies to encourage these women to join the mainstream HPV screening program.
- 1. Australian Government Department of Health. National Cervical Screening Program. Overview of the Renewal [website]. 2014. http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/overview-of-the-renewal (accessed Jan 2015).
- 2. Australian Government, Medical Services Advisory Committee. MSAC outcomes. Application no. 1276 — Renewal of the National Cervical Screening Program [public summary document]. 2014. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/FD36D6990FFAA639CA25799200058940/$File/1276%20-%20Final%20MSAC%20PSD%20-%20NCSP%20Renewal.pdf (accessed May 2015).
- 3. Cancer Council Australia. Cervical Cancer Prevention Guidelines Working Party. Clinical management guidelines for the prevention of cervical cancer. Draft NCSP policy. http://wiki.cancer.org.au/australia/Guidelines:Cervical_cancer/Prevention/Draft_NCSP_Policy (accessed Feb 2016).
- 4. Snijders PJ, Verhoef VM, Arbyn M, et al. High-risk HPV testing on self-sampled versus clinician-collected specimens: a review on the clinical accuracy and impact on population attendance in cervical cancer screening. Int J Cancer 2013; 132: 2223-2236.
- 5. Rijksinstituut voor Volksgezondheid en Milieu. Population screening is about to change [Dutch]. 2015. http://www.rivm.nl/Onderwerpen/B/Bevolkingsonderzoek_baarmoederhalskanker/Bevolkingsonderzoek_gaat_veranderen (accessed May 2015).
- 6. Arrossi S, Thouyaret L, Herrero R, et al. Effect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer (the EMA study): a population-based cluster-randomised trial. Lancet Glob Health 2015; 3: e85-e94.
- 7. Lazcano-Ponce E, Lőrincz AT, Torres L, et al. Specimen self-collection and HPV DNA screening in a pilot study of 100 242 women. Intern J Cancer 2014; 135: 109-116.
- 8. Arbyn M, Verdoodt F, Snijders PJ, et al. Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: a meta-analysis. Lancet Oncol 2014; 15: 172-183.
- 9. Arbyn M, Castle PE. Offering self-sampling kits for HPV testing to reach women who do not attend in the regular cervical cancer screening program. Cancer Epidemiol Biomarkers Prev 2015; 24: 769-772.
- 10. Lew JB, Simms K, Smith MA, et al. National Cervical Screening Program Renewal: Effectiveness modelling and economic evaluation in the Australian setting. MSAC application no. 1276: assessment report. Canberra: Department of Health and Ageing, 2014. http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/E6A211A6FFC29E2CCA257CED007FB678/$File/Renewal%20Economic%20Evaluation.pdf (accessed Jan 2015).
- 11. Smith MA, Canfell K. Testing previous model predictions against new data on human papillomavirus vaccination program outcomes. BMC Res Notes 2014; 7: 109.
- 12. Sultana F, English DR, Simpson JA, et al. Rationale and design of the iPap trial: a randomized controlled trial of home-based HPV self-sampling for improving participation in cervical screening by never- and under-screened women in Australia. BMC Cancer 2014; 14: 207.
- 13. Brotherton JM, Murray SL, Hall MA, et al. Human papillomavirus vaccine coverage among female Australian adolescents: success of the school-based approach. Med J Aust 2013; 199: 614-617. <MJA full text>
- 14. Brotherton JML, Liu B, Donovan B, et al. Human papillomavirus (HPV) vaccination coverage in young Australian women is higher than previously estimated: independent estimates from a nationally representative mobile phone survey. Vaccine 2014; 32: 592-597.
- 15. Effler P. School-based HPV immunisation programs: the WA experience [conference presentation]. Preventing Cervical Cancer (PCC 2015), Melbourne, 20–22 February 2015. http://www.pcc2015.org.au/presentations/19%20School%20Based%20HPV%20Vaccination%20coverage%20for%20students%20in%20WA%20v5.pdf (accessed Nov 2015).
- 16. Medical Services Advisory Committee. Automation-assisted and liquid based cytology for cervical cancer screening MSAC reference 1122: assessment report. Canberra: MSAC, 2009. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/4A82DCED02737781CA2575AD0082FDA7/$File/1122-LBC-AssessmentReport-250909-Accessibile.pdf (accessed Jan 2015).
- 17. Victorian Cervical Cytology Register. Statistical report 2013. Melbourne: VCCR, 2014. http://www.vccr.org/site/VCCR/filesystem/documents/dataandresearch/StatisticalReports/VCS_StatisticsReport_2013_Web_SinglePages_Final.pdf (accessed Jan 2015).
- 18. Aminisani N, Armstrong BK, Canfell K. Cervical cancer screening in Middle Eastern and Asian migrants to Australia: a record linkage study. Cancer Epidemiol 2012; 36: e394-e400.
- 19. Australian Institute of Health and Welfare. Cervical screening in Australia 2012–2013 (Cancer Series No. 93; Cat. No. CAN 91). Canberra: AIHW, 2015. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129550872 (accessed Jan 2015).
- 20. Coory MD, Fagan PS, Muller JM, Dunn NA. Participation in cervical cancer screening by women in rural and remote Aboriginal and Torres Strait Islander communities in Queensland. Med J Aust 2002; 177: 544-547. <MJA full text>
- 21. Binns PL, Condon JR. Participation in cervical screening by Indigenous women in the Northern Territory: a longitudinal study. Med J Aust 2006; 185: 490-494. <MJA full text>
- 22. Supramaniam R, O’Connell DL, Tracey E, Sitas F. Cancer incidence in New South Wales migrants 1991 to 2001 [website]. Sydney: Cancer Council NSW, 2006. http://www.cancercouncil.com.au/1715/research/research-documents/cancer-incidence-in-migrants-in-nsw-1991-to-2001-2/ (accessed Jan 2015).
- 23. Mullins R, Scalzo K, Sultana F. Self-sampling for cervical screening: could it overcome some of the barriers to the Pap test? J Med Screen 2014; 21: 201-206.
- 24. Rozemeijer K, de Kok IMCM, Naber SK, et al. Offering self-sampling to non-attendees of organized primary HPV screening: when do harms outweigh the benefits? Cancer Epidemiol Biomarkers Prev 2015; 24: 773-782.
- 25. Gertig DM, Brotherton JM, Budd AC, et al. Impact of a population-based HPV vaccination program on cervical abnormalities: a data linkage study. BMC Med 2013; 11: 227.
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