Projected time to elimination of cervical cancer in the USA: a comparative modelling study.
Projected time to elimination of cervical cancer in the USA: a comparative modelling study.
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DOI：
10.1016/s2468-2667(20)30006-2
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发表时间：
2020-04
期刊：
影响因子：
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通讯作者：
Kim JJ
中科院分区：
文献类型：
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作者：
Burger EA;Smith MA;Killen J;Sy S;Simms KT;Canfell K;Kim JJ
2018年5月，世界卫生组织（世卫组织）总干事发出全球呼吁，呼吁将宫颈癌（CC）作为一个公共卫生问题消除，这将涉及制定雄心勃勃的筛查和疫苗接种覆盖率目标。我们使用癌症干预和监测建模网络（CISNET）的两个模型进行了比较建模分析，以探讨采用WHO概述的CC覆盖目标对美国宫颈癌发病率的影响。我们使用了两个独立开发的CISNET模型，该模型涉及动态多队列建模平台，以捕获人乳头瘤病毒（HPV）诱导的CC随时间的变化，包括疫苗接种的群体效应。我们评估了9种替代预防性HPV疫苗接种和宫颈筛查规模扩大的方案，并与“现状”方案进行了比较，“现状”方案在CC消除阈值为4例/100，000名妇女的背景下不涉及额外干预。在现状假设下，两个模型都预测到2038-2046年，CC发病率将降至4/100，000女性以下。将筛查覆盖率扩大到90%是加快消除时间（提前10-13年）和相对癌症减少方面最有效的干预措施，在2020-2100年期间每年平均避免1，400 - 2，088例额外病例。将HPV疫苗接种覆盖率提高到90%或接种26-45岁的成年人对CC发病率的影响最小。使用不同人口结构的敏感性分析产生了围绕“现状”预测的-10/+27年的范围。这些经过验证的CISNET-Cervical模型反映了CC自然史的不确定性，发现美国有望在2038-2046年之前消除宫颈癌这一公共卫生问题。如果实现更高的筛查覆盖率，消除时间可以提前到2028-2033年。这些国家平均估计数并不适用于所有妇女亚组;因此，覆盖筛查不足和接种不足的妇女仍然是实现所有妇女消除CC的关键。
In May 2018, the World Health Organization (WHO) Director-General issued a global call to eliminate cervical cancer (CC) as a public health problem, which will involve setting ambitious screening and vaccination coverage targets. We performed a comparative modeling analysis using two models from the Cancer Intervention and Surveillance Modeling Network (CISNET) to explore the impact of adopting CC coverage targets outlined by the WHO on cervical cancer incidence in the United States. We used two independently-developed CISNET models that involved a dynamic multicohort-modeling platform to capture changes in human papillomavirus (HPV)-induced CC over time, including herd effects from vaccination. We evaluated nine alternative prophylactic HPV vaccination and cervical screening scale-up scenarios compared with a ‘status quo’ scenario that involved no additional interventions in the context of a threshold for CC elimination of 4 cases/100,000 women. Under status-quo assumptions, both models projected that CC incidence would fall below 4/100,000 women by year 2038–2046. Scaling up screening coverage to 90% was the most impactful intervention in terms of expediting elimination timing (10–13 years earlier) and relative cancer reductions, averting an average of 1,400–2,088 additional cases per year over 2020–2100. Increasing HPV vaccination coverage to 90% or vaccinating adults aged 26–45 years had minimal impacts on CC incidence. Sensitivity analysis using different population structures generated a range of −10/+27 years around ‘status quo’ predictions. These validated CISNET-Cervical models, which reflect uncertainty in the natural history of CC, found that the United States is on track to eliminate cervical cancer as a public health problem by 2038–2046. Elimination timing could be brought forward to 2028–2033 if higher screening coverage is achieved. These national average estimates do not apply to all subgroups of women; therefore, reaching under-screened and under-vaccinated women remain key to achieving CC elimination for all women.