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Cytologic HPV screening every 3 years ideal for women aged 21 to 29
A recent study of cancer screening strategies found that cytologic testing every 3 years in women aged 21 to 29 years, with continued cytologic testing every 3 years or a switch to low-cost, high-risk HPV testing every 5 years in women aged 30 to 65 years, provided the best balance of benefits, harms and costs.
“Although large declines in cervical cancer incidence and mortality in the United States have accompanied widespread screening with cervical cytologic testing, screening options have greatly expanded beyond cytologic testing alone,” George F. Sawaya, MD, of the department of obstetrics, gynecology and reproductive sciences and the Center for Healthcare Value at the University of California, San Francisco, and colleagues wrote.
Researchers evaluated the following cervical cancer screening strategies: cytologic testing every 3 years in women aged 21 to 65 years old, with atypical squamous cells of undetermined significance managed with repeat cytologic testing at 1 year or immediate high-risk HPV triage; or cytologic testing every 3 years in women aged 21 to 29 with continued cytologic testing and high-risk HPV cotesting, or high-risk HPV testing alone for women aged 30 to 65 years.
To determine the cost-effectiveness of the screening strategies, researchers conducted four focus groups made up of sociodemographically diverse women aged 21 to 65 years. Participants were recruited from two women’s health clinics in San Francisco from Sept. 22, 2014, to June 16, 2016. Those involved in the focus groups were enrolled in a cross-sectional study that began with a 50-minute face-to-face interview and included a questionnaire and an educational video. Participants then selected preferences for 23 cervical cancer screening-associated health states, which were then applied to a decision model for type-specific high-risk HPV-induced cervical carcinogenesis. Researchers used systematic reviews of screening tests, including the 2017 Cochrane review, to estimate for test accuracy.
Data from 451 women (258 nonwhite) with a mean age of 38.2 years were included in the study. Researchers found that the greatest number of lifetime quality of life years (QALYs) was associated with cytologic testing every 3 years with repeat cytologic testing for atypical squamous cells of undetermined significance. The strategy created more QALYs at a higher cost compared with the low-cost strategy, cytologic testing every 3 years with high-risk HPV triage of atypical squamous cells of undetermined significance.
Researchers found that cytologic testing with high-risk HPV cotesting yielded fewer QALYs at higher costs. Results from a sensitivity analysis showed that high-risk HPV testing every 5 years after 30 years of age was the lowest cost strategy when high-risk HPV test sensitivity was higher compared with cytologic test sensitivity, and when high-risk HPV test cost was the same as the lowest reported cytologic test cost.
“Identifying and promoting strategies that maximize quality of life outcomes and minimize costs at all steps throughout the screening process will provide higher-value cervical cancer screening from the perspectives of society, the health care sector, and women,” Sawaya and colleagues wrote. – by Erin Michael
Disclosures: Sawaya reported receiving grants from the National Cancer Institute during the conduct of the study. Please see study for all other authors’ relevant financial disclosures.