Comparative Modeling to Inform Cervical Cancer Control Policies: USPSTF Supplement

项目总结 美国预防服务工作组(USPSTF)上次更新宫颈癌筛查的时间 指南在2018年8月，他们增加了一项建议，每5年筛查一次高危人群 除了先前推荐的宫颈筛查策略外，仅进行乳头瘤病毒(HrHPV)检测 30至65岁女性的癌症，包括每三年单独或每隔一年进行一次宫颈细胞学筛查 5年hrHPV检测结合细胞学(联合检测)。从那时起，出现了新的数据， 可能会改变关于平均而言宫颈癌筛查利弊平衡的结论- 高风险和低风险女性。特别是，已经公布了关于性能和 HrHPV检测的可接受性，特别是在亚组人群中(即按年龄和接种状况)。 此外，自我采集阴道样本用于hrhpv检测的新兴用途可能会促进公平。 在某些筛查不足的人群中获得宫颈癌筛查的机会。 对于这一行政补充，我们建议与USPSTF及其证据实践中心合作 (EPC)使用模拟模型来综合这一新知识，并评估 另一种宫颈癌筛查策略。具体地说，我们的目标是使用四个成熟的模拟 模型：(1)估计不同年龄段美国成年女性的一生结局 宫颈癌筛查方案--结果将包括好处(例如，宫颈癌病例和死亡 避免、寿命年增加)、危害(假阴性结果、假阳性结果、镜检查次数和 切除治疗)，以及不同策略的相对效率。场景可能因形态不同而不同， 筛查间隔、年龄和接种情况；(2)探索是否可以使用自我收集hrHPV来减少 宫颈癌在某些亚组人群中的差异；以及(3)探索与 中等风险人群，在利益、危害和筛查效率的平衡上存在差异 人口关键分组的战略(例如，按种族、疫苗接种状况)。 这些结果旨在为宫颈癌的危害和益处的权衡提供证据。 在USPSTF从2018年开始重新评估指南时进行筛选，以通知他们。

PROJECT SUMMARY When the US Preventive Services Task Force (USPSTF) last updated their cervical cancer screening guidelines in August 2018, they added a recommendation for screening every 5 years with high-risk human papillomavirus (hrHPV) testing alone in addition to previously recommended screening strategies for cervical cancer for women aged 30 to 65 years, including screening every 3 years with cervical cytology alone or every 5 years with hrHPV testing in combination with cytology (cotesting). Since then, new data have emerged that could change conclusions about the balance of benefits and harms of cervical cancer screening for average- risk and low-risk women. In particular, new evidence has been published regarding the performance and acceptability of hrHPV testing, especially in subgroup populations (i.e., by age and vaccination status). Moreover, the emerging use of self-collection of vaginal samples for hrHPV testing may promote equitable access to cervical cancer screening among certain underscreened populations. For this administrative supplement, we propose to work with the USPSTF and their evidence practice center (EPC) to use simulation models to synthesize this new knowledge and evaluate the harms and benefits of alternative cervical cancer screening strategies. Specifically, we aim to use four well-established simulation models to: (1) Estimate the lifetime outcomes across the US population of adult women under different scenarios for cervical cancer screening - outcomes will include benefits (e.g., cervical cancer cases and deaths averted, gains in life years), harms (false-negative results, false positive findings, number of colposcopies and excisional treatments), and the relative efficiency of different strategies. Scenarios may vary by modality, screening interval, age and vaccination status; (2) Explore if self-collection of hrHPV may be used to reduce cervical cancer disparities for certain sub-group populations; and (3) Explore whether compared to the average-risk population, there are differences in the balance of benefits, harms and efficiency of screening strategies in key sub-groups of the population (e.g., by race, vaccination status). These results are intended to provide evidence on the tradeoffs of harms and benefits of cervical cancer screening to inform the USPSTF as they re-evaluate guidelines from 2018.