Burger Emily A, Jansen Erik E L, de Bondt Daniël, Killen James, Spencer Jennifer C, Regan Mary Caroline, Smith Megan A, Sy Stephen, Canfell Karen, de Kok Inge M C M, Kim Jane J, Hontelez Jan A C
Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States.
Department of Health Management and Health Economics, University of Oslo, Oslo 0317, Norway.
J Natl Cancer Inst. 2025 Jul 1;117(7):1498-1502. doi: 10.1093/jnci/djae319.
Population-level estimates in time frames for reaching cervical cancer elimination (ie, <4 cases per 100 000 women) in the United States may mask potential disparities in achieving elimination among subpopulations. We used 3 independent Cancer Intervention and Surveillance Modeling Network models to estimate differences in the time to cervical cancer elimination across 7 strata of correlated screening and human papillomavirus vaccination uptake, based on national survey data. Compared with the average population, elimination was achieved at least 22 years earlier for the high-uptake strata and at least 27 years later for the most extreme low-uptake strata. Accounting for correlated uptake impacted the population average time frame by no more than 1 year. Consequently, national average elimination time frames mask substantial disparities in reaching elimination among subpopulations. Addressing inequalities in cervical cancer control could shorten elimination time frames and would ensure more equitable elimination across populations. Furthermore, country-level elimination monitoring could be supplemented by monitoring progress in subpopulations.
美国在实现消除宫颈癌（即每10万名女性中少于4例病例）的时间框架内进行的总体估计，可能掩盖了亚人群在实现消除方面的潜在差异。我们使用了3个独立的癌症干预和监测建模网络模型，根据全国调查数据，估计了在7个相关筛查和人乳头瘤病毒疫苗接种率分层中，实现消除宫颈癌所需时间的差异。与普通人群相比，高接种率分层至少提前22年实现消除，而最极端的低接种率分层则至少推迟27年。考虑相关接种率对总体平均时间框架的影响不超过1年。因此，全国平均消除时间框架掩盖了亚人群在实现消除方面的巨大差异。解决宫颈癌控制中的不平等问题可以缩短消除时间框架，并确保在人群中更公平地实现消除。此外，在国家层面进行消除监测的同时，可以补充对亚人群进展情况的监测。
