Cytology and cervical cancer surveillance in an era of human papillomavirus vaccination

Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 328 ◽  
Author(s):  
Alison C. Budd ◽  
Christine J. Sturrock
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Hpv Vaccine ◽  
Screening Program ◽  
Cervical Screening ◽  
Cancer Surveillance ◽  
Human Papillomavirus Vaccination ◽  
Incidence Data ◽  
National Monitoring

Cytological and cancer surveillance will provide the most effective indications of short-term effects and long-term outcomes of the introduction of the human papillomavirus (HPV) vaccine in Australia. This article outlines how this surveillance is proposed to occur through the established national monitoring mechanisms of the National Cervical Screening Program in the annual Australian Institute of Health and Welfare (AIHW) publication ‘Cervical screening in Australia’. Cytological surveillance will be possible principally through cytology data provided annually by the state and territory cervical cytology registers, and it is expected that these data will provide the earliest and most comprehensive indications of effects from the HPV vaccine. Some potential issues in interpreting these data are also discussed, including the potentially confounding effects of the introduction of new National Health and Medical Research Council guidelines ‘Screening to prevent cervical cancer: guidelines for the management of asymptomatic women with screen-detected abnormalities’ some 9 months before the introduction of the vaccine. Cancer surveillance over the long term will be possible using cervical cancer incidence data reported annually for the National Cervical Screening Program in ‘Cervical screening in Australia’ using data sourced from the Australian Cancer Database. In a final discourse, the HPV vaccine and cervical screening are discussed concurrently, and the importance of continued cervical screening in the HPV vaccine era emphasised.

Models of cervical screening in the era of human papillomavirus vaccination

Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 359 ◽  
Author(s):  
Karen Canfell
Keyword(s):  
Human Papillomavirus ◽  
Screening Program ◽  
Cervical Screening ◽  
Age Groups ◽  
Simulation Modelling ◽  
Term Effect ◽  
Short Term ◽  
Human Papillomavirus Vaccination ◽  
Long Term Effect

Epidemiologic and economic evaluation using simulation modelling can support complex policy decisions, and is an important tool in predicting the future interaction between human papillomavirus vaccination and cervical screening. Several categories of screening program evaluation are of interest, including: (1) changes to screening considered over the short term, over which the effects of vaccination should be confined to the youngest age groups (<30 years old); (2) the medium and long-term effect of vaccination on the screening program; and (3) changes to screening in context of vaccination. This review considers some of the policy questions in each category and discusses the modelling implications, with particular focus on the Australian context.

A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program

Sexual Health ◽  
2007 ◽  
Vol 4 (3) ◽  
pp. 165 ◽  
Author(s):  
Shalini Kulasingam ◽  
Luke Connelly ◽  
Elizabeth Conway ◽  
Jane S. Hocking ◽  
Evan Myers ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cost Effectiveness ◽  
Hpv Vaccine ◽  
Screening Program ◽  
Herd Immunity ◽  
Vaccination Program ◽  
Catch Up ◽  
The Cost ◽  
Current Screening

Background: The cost-effectiveness of adding a human papillomavirus (HPV) vaccine to the Australian National Cervical Screening Program compared to screening alone was examined. Methods: A Markov model of the natural history of HPV infection that incorporates screening and vaccination was developed. A vaccine that prevents 100% of HPV 16/18-associated disease, with a lifetime duration of efficacy and 80% coverage offered through a school program to girls aged 12 years, in conjunction with current screening was compared with screening alone using cost (in Australian dollars) per life-year (LY) saved and quality-adjusted life-year (QALY) saved. Sensitivity analyses included determining the cost-effectiveness of offering a catch-up vaccination program to 14–26-year-olds and accounting for the benefits of herd immunity. Results: Vaccination with screening compared with screening alone was associated with an incremental cost-effectiveness ratio (ICER) of $51 103 per LY and $18 735 per QALY, assuming a cost per vaccine dose of $115. Results were sensitive to assumptions about the duration of vaccine efficacy, including the need for a booster ($68 158 per LY and $24 988 per QALY) to produce lifetime immunity. Accounting for herd immunity resulted in a more attractive ICER ($36 343 per LY and $13 316 per QALY) for girls only. The cost per LY of vaccinating boys and girls was $92 052 and the cost per QALY was $33 644. The cost per LY of implementing a catch-up vaccination program ranged from $45 652 ($16 727 per QALY) for extending vaccination to 14-year-olds to $78 702 ($34 536 per QALY) for 26-year-olds. Conclusions: These results suggest that adding an HPV vaccine to Australia’s current screening regimen is a potentially cost-effective way to reduce cervical cancer and the clinical interventions that are currently associated with its prevention via screening alone.

scholarly journals Cost-effectiveness of a bivalent human papillomavirus vaccination program in Japan

Sexual Health ◽  
2015 ◽  
Vol 12 (6) ◽  
pp. 520 ◽  
Author(s):  
Luke B. Connelly ◽  
Ha N. D. Le
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cost Effectiveness ◽  
Screening Program ◽  
Vaccine Coverage ◽  
Precancerous Lesions ◽  
Hpv Vaccination ◽  
Vaccination Program ◽  
Human Papillomavirus Vaccination ◽  
The Cost

Background Human papillomavirus (HPV) vaccines and their widespread adoption have the potential to relieve a large part of the burden of cervical cancer morbidity and mortality, particularly in countries that have low screening rates or, like Japan, lack a cohesive universal screening program. An economic evaluation was conducted to assess the cost-effectiveness of introducing a bivalent HPV vaccination program in Japan from a healthcare perspective. Methods: A Markov model of the natural history of HPV infection that incorporates both vaccination and screening was developed for Japan. The modelled intervention, a bivalent HPV vaccine with a 100% lifetime vaccine efficacy and 80% vaccine coverage, given to a cohort of 12-year-old Japanese girls in conjunction with the current screening program, was compared with screening alone in terms of costs and effectiveness. A discount rate of 5% was applied to both costs and utilities where relevant. Results: Vaccination alongside screening compared with screening alone is associated with an incremental cost-effectiveness ratio (ICER) of US$20 315 per quality-adjusted-life-year gained if 80% coverage is assumed. The ICER at 5% coverage with the vaccine plus screening, compared with screening alone, is US$1158. Conclusion: The cost-effectiveness results suggest that the addition of a HPV vaccination program to Japan’s cervical cancer screening program is highly likely to prove a cost-effective way to reduce the burden of cervical cancer, precancerous lesions and HPV16/18-related diseases.

Cost-effectiveness analysis of the introduction of a quadrivalent human papillomavirus vaccine in France

2008 ◽  
Vol 24 (01) ◽  
pp. 10-19 ◽  
Author(s):  
Christine Bergeron ◽  
Nathalie Largeron ◽  
Ruth McAllister ◽  
Patrice Mathevet ◽  
Vanessa Remy
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Hpv Vaccine ◽  
Screening Program ◽  
Sensitivity Analyses ◽  
Quadrivalent Hpv Vaccine ◽  
Hpv Types ◽  
Current Screening

Objectives:A vaccine to prevent diseases due to human papillomavirus (HPV) types 6, 11, 16, and 18 is now available in France. The objective of this study was to assess the health and economic impact in France of implementing a quadrivalent HPV vaccine alongside existing screening practices versus screening alone.Methods:A Markov model of the natural history of HPV infection incorporating screening and vaccination, was adapted to the French context. A vaccine that would prevent 100 percent of HPV 6, 11, 16, and 18-associated diseases, with lifetime duration and 80 percent coverage, given to girls at age 14 in conjunction with current screening was compared with screening alone. Results were analyzed from both a direct healthcare cost perspective (DCP) and a third-party payer perspective (TPP). Indirect costs such as productivity loss were not taken into account in this analysis.Results:The incremental cost per life-year gained from vaccination was €12,429 (TPP) and €20,455 (DCP). The incremental cost per quality-adjusted life-year (QALY) for the introduction of HPV vaccination alongside the French cervical cancer screening program was €8,408 (TPP) and €13,809 (DCP). Sensitivity analyses demonstrated that cost-effectiveness was stable, but was most sensitive to the discount rate used for costs and benefits.Conclusions:Considering the commonly accepted threshold of €50,000 per QALY, these analyses support the fact that adding a quadrivalent HPV vaccine to the current screening program in France is a cost-effective strategy for reducing the burden of cervical cancer, precancerous lesions, and genital warts caused by HPV types 6, 11, 16, and 18.

54. CAPITALISING ON THE UNIQUE OPPORTUNITY OF THE HPV VACCINE, FOR A CERVICAL SCREENING PROGRAM

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 305
Author(s):  
L. Rawlings
Keyword(s):  
Cervical Cancer ◽  
Hpv Vaccine ◽  
Screening Program ◽  
Cervical Screening ◽  
Hpv Vaccination ◽  
National Immunisation ◽  
Expert Opinions ◽  
Current Program ◽  
Huge Impact ◽  
Research And Education

The medical advancement of the human papilloma virus (HPV) vaccine and it's swift addition to the National Immunisation Program, caused a sudden surge in the public's awareness and interest in HPV. The challenge for PapScreen Victoria, a state based cervical screening program, was to react quickly and strategically to ensure that this new knowledge did not prevent women from having Pap tests. PapScreen pre-empted that the vaccine would have a huge impact on the current program, and undertook an educational journey to identify issues. The program sought expert opinions, formulated new partnerships in the immunisation sector and examined the current research. The program identified that its role was to inform women about HPV and the importance to continue screening in this new era of HPV vaccination. In the prevention of cervical cancer, there was also a role to inform health professionals, parents and young women about the benefits of the vaccine. The challenge was capatilising on the unique opportunity that the vaccine created. Developing and implementing strategies quickly was paramount in the program's success on capitalising this interest. Across three main areas - community, communications and research - the program implemented a range of strategies, including new resources, media opportunities, formative research and education, among others. PapScreen's aim was to remain the prime source of information for the prevention of cervical cancer in Victoria. The success of these strategies has been profound and immunisation messages are now included in all program messages across a range of sectors. The program was able to capitalise on this unique occasion by being flexible, proactive and strategically adaptable to the public health environment.

scholarly journals Cervical Cancer and Human Papillomavirus Awareness among Women in Saudi Arabia

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1373
Author(s):  
Khalid Akkour ◽  
Lolowah Alghuson ◽  
Hicham Benabdelkamel ◽  
Hani Alhalal ◽  
Nada Alayed ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Saudi Arabia ◽  
Human Papillomavirus ◽  
Hpv Vaccine ◽  
Public Awareness ◽  
Cervical Screening ◽  
The Internet ◽  
Cross Sectional ◽  
Saudi Women ◽  
Source Of Information

Background and Objectives: Cervical cancer (CC) is the eighth most common cancer among Saudi women of all ages. With limited national data, we aimed to evaluate the public awareness of cervical cancer, CC risk factors, HPV infection, and HPV vaccines in different regions of Saudi Arabia. Materials and Methods: This was a survey-based cross-sectional study that encompassed 564 Saudi women over a period of a month. A self-administrated questionnaire was distributed through different social media platforms. Results: The collected data included sociodemographic variables and questions assessing awareness of CC, and the attitudes toward CC screening and human papillomavirus (HPV) vaccination. Most respondents were aware of CC (84.0%), although their primary source of information was the internet. However, only 45 females (8.0%) had a history of cervical screening. Furthermore, most females did not know that HPV was transmitted sexually (78.9%), or that it caused genital warts (81.7%) and CC (81.9%). Regarding the HPV vaccine, 100 females (17.7%) had heard about it, but only 11 (2.0%) took the vaccine, although more than half of the respondents (54.1%) were willing to take the vaccine after being informed about it. Conclusions: We noticed a remarkable lack of awareness among the respondents regarding HPV’s clinical implications; and the HPV vaccine, and its importance and availability. The main source of information for most of the Saudi women in this study was the internet, which may be an unreliable source, or provide misleading information that may delay screening or discourage vaccination. Thus, organized campaigns by the Ministry of Health or other health-advocating agencies, in addition to screening and vaccination programs, are strongly encouraged.

Promising strategies for cervical cancer screening in the post-human papillomavirus vaccination era

Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 376 ◽  
Author(s):  
Joseph Tota ◽  
Salaheddin M. Mahmud ◽  
Alex Ferenczy ◽  
François Coutlée ◽  
Eduardo L. Franco
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Human Error ◽  
Pap Smear ◽  
Cervical Screening ◽  
Screening Tests ◽  
Hpv Testing ◽  
Human Papillomavirus Vaccination ◽  
Screening Programs

Human papillomavirus (HPV) vaccination is expected to reduce the burden of cervical cancer in most settings; however, it is also expected to interfere with the effectiveness of screening. In the future, maintaining Pap cytology as the primary cervical screening test may become too costly. As the prevalence of cervical dysplasias decreases, the positive predictive value of the Pap test will also decrease, and, as a result, more women will be referred for unnecessary diagnostic procedures and follow-up. HPV DNA testing has recently emerged as the most likely candidate to replace cytology for primary screening. It is less prone to human error and much more sensitive than the Pap smear in detecting high-grade cervical lesions. Incorporating this test would improve the overall quality of screening programs and allow spacing out screening tests, while maintaining safety and lowering costs. Although HPV testing is less specific than Pap cytology, this issue could be resolved by reserving the latter for the more labour-efficient task of triaging HPV-positive cases. Because most HPV-positive smears would contain relevant abnormalities, Pap cytology would be expected to perform with sufficient accuracy under these circumstances. HPV Pap triage would also provide a low-cost strategy to monitor long-term vaccine efficacy. Although demonstration projects could start implementing HPV testing as a population screening tool, more research is needed to determine the optimal age to initiate screening, the role of HPV typing and other markers of disease progression, and appropriate follow-up algorithms for HPV-positive and Pap-negative women.

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