School of Medicine, Trinity College Dublin, Dublin, Ireland
School of Physical Sciences, Dublin City University, Dublin, Ireland.
BMJ Open. 2024 Feb 2;14(2):e078551. doi: 10.1136/bmjopen-2023-078551.
Cervical screening is a life-saving intervention, which reduces the incidence of and mortality from cervical cancer in the population. Human papillomavirus (HPV) based screening modalities hold unique promise in improving screening accuracy. HPV prevalence varies markedly by age, as does resultant cervical intraepithelial neoplasia (CIN), with higher rates recorded in younger women. With the advent of effective vaccination for HPV drastically reducing prevalence of both HPV and CIN, it is critical to model how the accuracy of different screening approaches varies with age cohort and vaccination status. This work establishes a model for the age-specific prevalence of HPV factoring in vaccine coverage and predicts how the accuracy of common screening modalities is affected by age profile and vaccine uptake.
Modelling study of HPV infection rates by age, ascertained from European cohorts prior to the introduction of vaccination. Reductions in HPV due to vaccination were estimated from the bounds predicted from multiple modelling studies, yielding a model for age-varying HPV and CIN grades 2 and above (CIN2+) prevalence.
Performance of both conventional liquid-based cytology (LBC) screening and HPV screening with LBC reflex (HPV reflex) was estimated under different simulated age cohorts and vaccination levels.
Simulated populations of varying age and vaccination status.
HPV-reflex modalities consistently result in much lower incidence of false positives than LBC testing, with an accuracy that improves even as HPV and CIN2+ rates decline.
HPV-reflex tests outperform LBC tests across all age profiles, resulting in greater test accuracy. This improvement is especially pronounced as HPV infection rates fall and suggests HPV-reflex modalities are robust to future changes in the epidemiology of HPV.
宫颈筛查是一种挽救生命的干预措施，可降低人群中宫颈癌的发病率和死亡率。基于人乳头瘤病毒（HPV）的筛查方法在提高筛查准确性方面具有独特的优势。HPV 的流行率随年龄而变化，宫颈上皮内瘤变（CIN）的发生率也随之变化，年轻女性的发生率较高。由于 HPV 的有效疫苗接种大大降低了 HPV 和 CIN 的流行率，因此必须建立模型来了解不同筛查方法的准确性如何随年龄组和疫苗接种状态而变化。这项工作建立了一个考虑疫苗接种覆盖率的 HPV 特定年龄流行率模型，并预测了常见筛查方法的准确性如何受年龄分布和疫苗接种率的影响。
对欧洲队列在接种疫苗前的 HPV 感染率进行年龄别建模研究。根据来自多个建模研究的预测范围，估计疫苗接种对 HPV 的减少量，从而建立一个 HPV 和 CIN 2 级及以上（CIN2+）流行率随年龄变化的模型。
根据不同模拟年龄组和疫苗接种水平，估计常规液基细胞学（LBC）筛查和 LBC 反射 HPV 筛查（HPV 反射）的性能。
不同年龄和疫苗接种状态的模拟人群。
HPV 反射方法比 LBC 检测产生的假阳性率低得多，即使 HPV 和 CIN2+的发生率下降，其准确性也会提高。
HPV 反射测试在所有年龄组中均优于 LBC 测试，从而提高了测试准确性。随着 HPV 感染率的下降，这种改善尤为明显，这表明 HPV 反射方法对 HPV 流行病学的未来变化具有稳健性。
