Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Mathematics and Statistics, University of New South Wales, Sydney, Australia.
Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia.
Gynecol Oncol. 2019 Mar;152(3):472-479. doi: 10.1016/j.ygyno.2018.10.045.
In response to emergent evidence, many countries are transitioning from cytology-based to HPV screening. We evaluated the impact of an upcoming transition on health outcomes and resource utilisation in New Zealand.
An extensively validated model of HPV transmission, vaccination, natural history and cervical screening ('Policy1-Cervix') was utilised to simulate a transition from three-yearly cytology for women 20-69 years to five-yearly HPV screening with 16/18 genotyping for women 25-69 years, accounting for population growth and the impact of HPV immunisation. Cervical cancer rates, resources use (test volumes), costs, and test positivity rates from 2015 to 2035 were estimated.
By 2035, the transition to HPV screening will result in declines in cervical cancer incidence and mortality rates by 32% and 25%, respectively, compared to 2018. A potentially detectable 5% increase in cervical cancer incidence due to earlier detection is predicted for the year of transition. Annual numbers of women screened will fluctuate with the five-year screening interval. Cytology volumes will reduce by over 80% but colposcopy volumes will be similar to pre-transition rates, and program costs will be reduced by 16%. A 9% HPV test positivity rate is expected in the first round of HPV screening (2019-2023), with 2.7% of women referred for colposcopy. Transitioning from cytology to primary HPV cervical screening could avert 149 cancer cases and 45 deaths by 2035.
Primary HPV screening and vaccination will reduce cervical cancer and resources use. A small transient apparent increase of invasive cancer rates due to earlier detection may be detectable at the population level, reflecting the introduction of a more sensitive screening test. These findings can be used to inform health services planning and public communications surrounding program implementation.
针对新出现的证据，许多国家正在从基于细胞学的筛查转向 HPV 筛查。我们评估了新西兰即将进行的这种转变对健康结果和资源利用的影响。
利用一种经过广泛验证的 HPV 传播、疫苗接种、自然史和宫颈筛查模型（“Policy1-Cervix”），模拟对 20-69 岁女性进行三年一次细胞学检查，对 25-69 岁女性进行五年一次 HPV 筛查并进行 16/18 基因分型，同时考虑到人口增长和 HPV 免疫接种的影响。估计了 2015 年至 2035 年期间的宫颈癌发病率、资源利用（检测量）、成本和检测阳性率。
到 2035 年，与 2018 年相比，HPV 筛查的转变将使宫颈癌发病率和死亡率分别下降 32%和 25%。预计在过渡年，由于早期检测，宫颈癌发病率将出现可检测到的 5%的上升。每年接受筛查的女性人数将随五年筛查间隔而波动。细胞学检查量将减少 80%以上，但阴道镜检查量与过渡前的水平相似，且项目成本将减少 16%。预计第一轮 HPV 筛查（2019-2023 年）HPV 检测阳性率为 9%，有 2.7%的女性被转诊进行阴道镜检查。到 2035 年，从细胞学检查转向 HPV 宫颈癌初筛可以避免 149 例癌症病例和 45 例死亡。
HPV 初筛和疫苗接种将降低宫颈癌和资源利用。由于早期检测，人群水平可能会检测到宫颈癌发病率的暂时性轻微增加，这反映了更敏感的筛查检测的引入。这些发现可用于为卫生服务规划和计划实施的公众宣传提供信息。
