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Disparities considered in cervical cancer screening
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By modeling disparities between subgroups, researchers identified screening strategies for cervical cancer that are cost-effective and provide aggregate health benefits compared with current methods, according to new findings in the Journal of the National Cancer Institute.
“Explicitly modeling disparities between subgroups according to our proposed typology of cancer disparities allowed us to identify points of overlap among effectiveness, equity and efficiency in the context of different options for cervical cancer prevention,” Sue J. Goldie, MD, MPH, of the department of health policy and management at Harvard School of Public Health, and colleagues wrote in the study. “We identified several strategies that would reduce the lifetime risk of cervical cancer across all subgroups, but the benefits were not equally distributed; while some strategies widened disparities between groups, others dramatically reduced them.”
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For the study, Goldie and Norman Daniels, PhD, professor of ethics and population health in the department of global health and population at Harvard School of Public Health, developed a typology of cancer disparities among black, white and Hispanic populations that identified inequalities resulting from factors such as access to and quality of treatment and prevention. Using this typology, they conducted an evaluation of cervical cancer screening and vaccination strategies, including vaccination against HPV and screening utilizing new test combinations and/or risk-based protocols. The evaluation calculated health and economic outcomes for the population as a whole, as well as the racial subgroups separately, including average reduction in cancer incidence, average costs and life expectancy per woman, and the cost-effectiveness ratio for each strategy.
The researchers found that combining HPV vaccination with current cervical cancer screening patterns resulted in an average 69% reduction in cancer incidence overall. However, reductions were unequally distributed, ranging from 63.9% for Hispanic women, 68.3% for black women and 71.6% for white women.
Other strategies targeting risk-based screening to racial and ethnic minorities provided similar or greater overall benefits, but reduced disparities among racial subgroups, with a 69.7% reduction in cervical cancer incidence among white women and 70.1% among Hispanic women, the researchers said.
Further, the researchers determined that screening strategies that directly targeted subgroups bearing the greatest inequalities, when combined with vaccination, were more effective than current screening patterns and had a cost-effectiveness ratio of $28,200 per year of life saved compared with the same strategy without vaccination, according to the study.
“This preliminary work represents a potential framework from which we can consider how to prioritize interventions that reduce inequalities that are most unjust while also considering their tractability,” the researchers wrote. “Use of decision analytic methods to explicitly quantify and examine both the population benefits and impact on disparities associated with different strategies allows us to identify those policy choices that might contribute to both equity and efficiency.”
In an accompanying editorial, Kevin A. Ault, MD, of the department of gynecology and obstetrics at Emory University School of Medicine, wrote: “The benefits of vaccination can potentially be distributed equitably across racial and ethnic groups, and they identify interventions for subgroups such as increased screening and the use of the more sensitive HPV test as strategies that both improve clinical outcomes and reduce health disparities. The authors refer to these interventions as a ‘win-win’ scenario, with substantial reductions in cervical cancer mortality across all subgroups of women and narrowing the gap in cervical cancer disparities.”
For more information:
- Ault KA. J Natl Cancer Inst. 2011;doi:10.1093/jnci/djr330.
- Goldie SJ. J Natl Cancer Inst. 2011;doi:10.1093/jnci/djr303.
Disclosure: This research was funded by the Agency for Healthcare Research and Quality (R01-HS015570-02); National Cancer Institute at the NIH (R01-CA093435).