Comparative Modeling to Inform Cervical Cancer Control Policies: USPSTF Supplement

项目摘要 当美国预防服务工作组（USPSTF）最后一次更新他们的宫颈癌筛查时， 在2018年8月的指南中，他们增加了一项建议，即每5年筛查一次高危人群。 除了先前推荐的宫颈癌筛查策略外， 年龄在30至65岁之间的女性，包括每3年进行一次宫颈细胞学筛查，或每3年进行一次宫颈细胞学筛查。 5年hrHPV检测与细胞学（cotesting）相结合。从那时起，新的数据显示， 可能会改变关于宫颈癌筛查的益处和危害平衡的结论， 低风险和低风险女性。特别是，新的证据已经公布的性能和 hrHPV检测的可接受性，特别是在亚组人群中（即，年龄和疫苗接种情况）。 此外，新出现的自行采集阴道样本进行hrHPV检测的方法可能会促进公平的 为某些筛查不足的人群提供宫颈癌筛查。 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些新知识，并评估 子宫颈癌筛查的替代策略。具体来说，我们的目标是使用四个完善的模拟 模型：（1）估计不同条件下美国成年女性人群的终身结局 宫颈癌筛查的方案-结果将包括益处（例如，宫颈癌病例和死亡 避免，生命年的收益），危害（假阴性结果，假阳性结果，阴道镜检查次数和 切除治疗），以及不同策略的相对效率。情景可能因模态而异， 筛查间隔、年龄和疫苗接种状态;（2）探索是否可以使用自我收集hrHPV来减少 某些亚组人群的宫颈癌差异;（3）探讨是否与 平均风险人群，在筛查的益处、危害和效率的平衡方面存在差异 人口中的关键亚群体的战略（例如，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 筛选通知USPSTF，因为他们从2018年开始重新评估指南。

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.