Zhao Ran, Kulasingam Shalini
Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA.
MDM Policy Pract. 2025 Jan 4;10(1):23814683241308905. doi: 10.1177/23814683241308905. eCollection 2025 Jan-Jun.
Cervical cancer screening can effectively reduce the disease burden. In China, the current cervical cancer screening guidelines do not provide separate screening recommendations for women living with HIV (WLWH) to account for their increased risk. We developed a comprehensive individual-based simulation model to provide evidence to support tailored cervical cancer screening programs for WLWH in Guangxi, a region with a high prevalence of HIV in China. Compared with the current screening coverage (i.e., the status quo), we evaluated the benefits and the harms associated with 9 cytology-based cervical cancer screenings tailored to WLWH in Guangxi. The 9 strategies vary in terms of screening interval (every 1, 3, or 5 y) and the age to exit screening (at age 65 y, 85 y, or no exit). All screening strategies evaluated were effective in reducing cervical cancers and cancer deaths among WLWH. Compared with the status quo, the percentage reduction in total cancers ranged from 18% to 60%, and the percentage reduction in cancer deaths ranged from 20% to 62%. Strategies with a 3- or 5-y screening interval had lower numbers of colposcopies per cancer and cancer deaths prevented. Implementing cytology-based cervical cancer screening among WLWH in Guangxi, China, can effectively prevent cervical cancer cases and cancer deaths. Our results suggest that adopting an older end age and a shorter screening interval might be more effective in preventing cancer cases and deaths but may also be associated with more screenings and potential harms and costs, while adopting a 3- or 5-y screening interval may provide a more reasonable balance of benefits and harms to prevent future cancer cases and deaths among WLWH in Guangxi, China.
Our comprehensive model can be used to evaluate various health interventions that aim to reduce the disease burden caused by HPV and cervical cancer.Cytology-based cervical cancer screening tailored to WLWH in Guangxi, China can effectively prevent cervical cancer cases and cancer deaths.Adopting a 3- or 5-y screening interval may provide a more reasonable balance of benefits and harms to prevent future cancer cases and deaths.
宫颈癌筛查可有效减轻疾病负担。在中国，当前的宫颈癌筛查指南并未针对感染艾滋病毒的女性（WLWH）给出单独的筛查建议，以考虑到她们增加的患病风险。我们开发了一个基于个体的综合模拟模型，以提供证据来支持为中国艾滋病高发地区广西的感染艾滋病毒女性制定量身定制的宫颈癌筛查项目。与当前的筛查覆盖率（即现状）相比，我们评估了针对广西感染艾滋病毒女性的9种基于细胞学的宫颈癌筛查的益处和危害。这9种策略在筛查间隔（每1年、3年或5年）以及停止筛查的年龄（65岁、85岁或不停止）方面各不相同。所评估的所有筛查策略在降低感染艾滋病毒女性的宫颈癌和癌症死亡方面均有效。与现状相比，癌症总数减少的百分比在18%至60%之间，癌症死亡减少的百分比在20%至62%之间。筛查间隔为3年或5年的策略每预防一例癌症和癌症死亡所需的阴道镜检查次数较少。在中国广西对感染艾滋病毒女性实施基于细胞学的宫颈癌筛查可有效预防宫颈癌病例和癌症死亡。我们的结果表明，采用较高的停止筛查年龄和较短的筛查间隔可能在预防癌症病例和死亡方面更有效，但也可能与更多的筛查以及潜在的危害和成本相关，而采用3年或5年的筛查间隔可能在预防未来中国广西感染艾滋病毒女性的癌症病例和死亡方面提供更合理的利弊平衡。
我们的综合模型可用于评估旨在减轻由人乳头瘤病毒和宫颈癌导致的疾病负担的各种健康干预措施。为中国广西感染艾滋病毒女性量身定制的基于细胞学的宫颈癌筛查可有效预防宫颈癌病例和癌症死亡。采用3年或5年的筛查间隔可能在预防未来癌症病例和死亡方面提供更合理的利弊平衡。
