Cancer Control Research (Pataky, Izadi-Najafabadi, Smith, Peacock), BC Cancer; Canadian Centre for Applied Research in Cancer Control (Pataky, Izadi-Najafabadi); Women's Health Research Institute (Smith, Ogilvie), BC Women's Hospital and Health Centre, Vancouver, BC; Karmanos Cancer Institute (Gottschlich), Wayne State University, Detroit Mich.; Faculty of Medicine (Ionescu, Proctor), University of British Columbia; Cervix Screening Program (Ionescu, Proctor), BC Cancer; School of Population and Public Health (Ogilvie), University of British Columbia; Faculty of Health Sciences (Peacock), Simon Fraser University, Vancouver, BC
Cancer Control Research (Pataky, Izadi-Najafabadi, Smith, Peacock), BC Cancer; Canadian Centre for Applied Research in Cancer Control (Pataky, Izadi-Najafabadi); Women's Health Research Institute (Smith, Ogilvie), BC Women's Hospital and Health Centre, Vancouver, BC; Karmanos Cancer Institute (Gottschlich), Wayne State University, Detroit Mich.; Faculty of Medicine (Ionescu, Proctor), University of British Columbia; Cervix Screening Program (Ionescu, Proctor), BC Cancer; School of Population and Public Health (Ogilvie), University of British Columbia; Faculty of Health Sciences (Peacock), Simon Fraser University, Vancouver, BC.
CMAJ. 2024 Jun 2;196(21):E716-E723. doi: 10.1503/cmaj.231682.
To eliminate cervical cancer in Canada by 2040, defined as an annual age-standardized incidence rate (ASIR) lower than 4.0 per 100 000 women, the Canadian Partnership Against Cancer (CPAC) identified 3 priorities for action: increasing human papillomavirus (HPV) vaccine coverage, implementing HPV-based screening and increasing screening participation, and improving follow-up after abnormal screen results. Our objective was to explore the impact of these priorities on the projected time to elimination of cervical cancer in British Columbia.
We used OncoSim-Cervical, a microsimulation model led and supported by CPAC and developed by Statistics Canada that simulates HPV transmission and the natural history of cervical cancer for the Canadian population. We updated model parameters to reflect BC's historical participation rates and program design. We simulated the transition to HPV-based screening and developed scenarios to explore the additional impact of achieving 90% vaccination coverage, 95% screening recruitment, 90% ontime screening, and 95% follow-up compliance. We projected cervical cancer incidence, ASIR, and year of elimination for the population of BC for 2023-2050.
HPV-based screening at current vaccination, participation, and follow-up rates can eliminate cervical cancer by 2034. Increasing on-time screening and follow-up compliance could achieve this target by 2031. Increasing vaccination coverage has a small impact over this time horizon.
With the implementation of HPV-based screening, cervical cancer can be eliminated in BC before 2040. Efforts to increase screening participation and follow-up through this transition could potentially accelerate this timeline, but the transition from cytology- to HPV-based screening is fundamental to achieving this goal.
为了在 2040 年前消除加拿大的宫颈癌，将每年年龄标准化发病率（ASIR）定义为低于每 10 万女性 4.0 例，加拿大癌症伙伴关系（CPAC）确定了 3 项优先行动：提高人乳头瘤病毒（HPV）疫苗覆盖率、实施 HPV 筛查和提高筛查参与率，以及改善异常筛查结果后的随访。我们的目标是探讨这些优先事项对卑诗省消除宫颈癌的预计时间的影响。
我们使用了 OncoSim-Cervical，这是一种由 CPAC 领导和支持、由加拿大统计局开发的微观模拟模型，用于模拟加拿大人口的 HPV 传播和宫颈癌的自然史。我们更新了模型参数，以反映卑诗省的历史参与率和项目设计。我们模拟了向 HPV 筛查的转变，并制定了方案来探索实现 90%疫苗接种覆盖率、95%筛查参与率、90%按时筛查和 95%随访依从性的额外影响。我们预测了卑诗省 2023-2050 年的宫颈癌发病率、ASIR 和消除年份。
在当前疫苗接种、参与率和随访率下，基于 HPV 的筛查可以在 2034 年消除宫颈癌。提高按时筛查和随访依从性可以在 2031 年达到这一目标。在这一时期内，增加疫苗接种覆盖率的影响很小。
随着 HPV 筛查的实施，卑诗省可以在 2040 年前消除宫颈癌。通过这一转变努力提高筛查参与率和随访率，可以潜在地加快这一时间表，但从细胞学筛查向 HPV 筛查的转变是实现这一目标的基础。
