Prevention of Cervical Cancer in the U.S.
Despite a widespread screening program in the U.S., more than 10,000 women were diagnosed with cervical cancer in 2008, and 4,000 women died of the disease. Recommendations for cervical cancer screening are under review as promising new approaches have become available, including vaccines targeting the cause of cervical cancer (human papillomavirus, HPV), as well as screening tests to detect infection with HPV DNA. This project seeks to assess the costs, benefits, and cost-effectiveness of primary (vaccination) and secondary prevention (screening). To estimate cost-effectiveness, or the value for resources expended on an intervention, we developed a computer simulation model with data specific to the incidence of cervical cancer in the United States and current US screening policies. Pressing issues related to cervical cancer screening include:
• the optimal use of HPV DNA testing in the context of a screening program based on frequent cytologic screening;
• how to reduce disparities evident in access to screening, incidence of cervical cancer, and death from cervical cancer;
• how to integrate a preventive HPV vaccine into existing screening programs; and
• how to contain costs related to cervical cancer control, especially in a time of economic distress.
Recent analyses funded by this project have concluded that HPV vaccination should target young girls, specifically younger than 21 years of age. HPV vaccination could lead to lower cervical cancer rates and be economically attractive if high coverage can be achieved in 12-year-old girls; catch-up programs for girls ages 13-18 could offer benefits and be reasonably cost-effective compared to other vaccine programs in the U.S. Correspondingly, if most 12-year-old girls are vaccinated, future cervical cancer screening could begin later than currently recommended and be conducted less frequently. For women older than age 30, HPV vaccination costs more for the health benefits than other accepted health care interventions in the US; for these women, less frequent screening with HPV DNA testing is more cost-effective than current screening recommendations. Finally, if HPV vaccination coverage and efficacy are high in girls, routine vaccination of boys is unlikely to provide comparative value to other public health interventions vying for resources. We continue to investigate the optimal cervical cancer control strategy for the US and results from our models are intended to assist in early decision making.