Global Health Unit, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
PLoS One. 2024 Oct 23;19(10):e0312295. doi: 10.1371/journal.pone.0312295. eCollection 2024.
The World Health Organization supports both the screen-and-treat (ST) approach and the screen, triage and treat (STT) approach to cervical cancer screening using high-risk human papillomavirus (hrHPV) testing. For Uganda, the sequence of hrHPV-ST and hrHPV-STT could be similar, with visual inspection with acetic acid (VIA) after positive hrHPV tests in both. To consider potential tradeoffs (overtreatment in ST versus missed cancer cases in STT), we compared hrHPV-STT with VIA triage (STT-VIA), and STT with HPV 16/18 genotyping risk stratification, to hrHPV-ST for Uganda, in terms of overtreatment, cervical cancer incidence, and life years, for the general female population of Uganda.
A microsimulation model of cervical cancer was adapted. Incremental benefit-harm ratios of STT were calculated as ratios of prevented overtreatment to reduced life years, and to increased cancer cases. Additional scenarios with 20% difference in intra- and inter-screening follow-up between ST and STT were modeled.
Both STT strategies resulted in life year losses on average compared to ST. STT-VIA prevented more overtreatment but led to increased cervical cancer incidence and life year losses. STT-G-VIA resulted in better harm-benefit ratios and additional costs. With better follow-up, STT prevented overtreatment and improved outcomes.
For Uganda, the STT approach appears preferrable, if the screening sequences of hrHPV-based ST and STT are similar in practice. While VIA triage alone would reduce overtreatment the most, it could also result in more cancer cases. Risk stratification via genotyping could improve STT. Potential follow-up differences and resource availability should be considered by decision-makers when planning Uganda's hrHPV-based screening strategy.
世界卫生组织支持使用高危型人乳头瘤病毒（hrHPV）检测的宫颈癌筛查的筛检-治疗（ST）方法和筛检、分类和治疗（STT）方法。对于乌干达，hrHPV-ST 和 hrHPV-STT 的顺序可能相似，两种方法在 hrHPV 检测阳性后都进行醋酸视觉检查（VIA）。为了考虑潜在的权衡（ST 中的过度治疗与 STT 中的癌症漏诊），我们比较了 hrHPV-STT 与 VIA 分类（STT-VIA），以及 STT 与 HPV16/18 基因分型风险分层与 hrHPV-ST 对于乌干达一般女性人群的过度治疗、宫颈癌发病率和生命年。
适应了宫颈癌微模拟模型。STT 的增量获益-危害比计算为预防过度治疗与减少生命年和增加癌症病例的比值。对 ST 和 STT 之间的内部和外部筛查随访有 20%差异的附加方案进行建模。
与 ST 相比，两种 STT 策略平均导致生命年损失。STT-VIA 可预防更多的过度治疗，但会导致宫颈癌发病率和生命年损失增加。STT-G-VIA 导致更好的危害-效益比和额外的成本。如果随访情况更好，STT 可预防过度治疗并改善结果。
对于乌干达，如果基于 hrHPV 的 ST 和 STT 的筛查序列在实践中相似，那么 STT 方法似乎更可取。虽然单独的 VIA 分类可最大程度地减少过度治疗，但也可能导致更多的癌症病例。通过基因分型进行风险分层可以改善 STT。决策者在规划乌干达基于 hrHPV 的筛查策略时应考虑潜在的随访差异和资源可用性。
