Comparative Effectiveness of the Cervical Cancer Screening Process: Past, Present

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Although Pap smear screening has reduced cervical cancer incidence in the United States, cervical cancer continues to be associated with substantial morbidity and mortality, contributes to racial and ethnic disparities, and Imposes high economic costs. Advances in cancer epidemiology and medical technology provide a remarkable opportunity to improve upon the effectiveness and efficiency of the cervical cancer screening process. However, critical challenges remain with respect to clinical decision making and adoption of best practices, pertaining to patient behavior, provider incentives, health systems, and the real-world clinical effectiveness of emerging technologies. We propose to employ a decision-analytic approach, adapting an existing modeling framework by leveraging data from clinical provider networks and a state-of-the-art registry of cervical cancer Information in New Mexico; evaluate and weigh the tradeoffs (benefits and harms) of alternative cervical interventions across the continuum of care; explore the uncertainty around their outcomes; incorporate information on patient behavior and real-world practice; and inform timely clinical and policy questions. By achieving our specific aims, we expect to have an impact on (1) the effectiveness and efficiency of the cervical cancer screening process by investigating the effects of acceptability, delivery, and adoption of best practices; (2) cervical cancer outcomes, including reduced incidence, enhanced quality of life through earlier detection, improved survival, and reduced disparities; (3) the equitable distribution and rationale use of new technology; and (4) the financial and economic profile of health care organizations related to cervical cancer control.