Background

Experts have proposed an ‘EVEN FASTER’ concept targeting age-groups maintaining circulation of human papillomavirus (HPV). We explored effects of the vaccination component of these proposals compared with cervical cancer (CC) screening-based interventions on age-standardized incidence rate (ASR) and CC elimination (<4 cases/100,000) timing in Norway.

Methods

We used a model-based approach to evaluate HPV vaccination and CC screening scenarios compared with a status-quo scenario reflecting previous vaccination and screening. For cohorts ages 25–30 years, we examined 6 vaccination scenarios that incrementally increased vaccination coverage from current cohort-specific rates. Each vaccination scenario was coupled with three screening strategies that varied screening frequency. Additionally, we included 4 scenarios that alternatively increased screening adherence. Population- and cohort-level outcomes included ASR, lifetime risk of CC, and colposcopy referrals.

Results

Several vaccination strategies coupled with de-intensified screening frequencies lowered ASR, but did not accelerate CC elimination. Alternative strategies that increased screening adherence could both accelerate elimination and improve ASR.

Conclusions

The vaccination component of an ‘EVEN FASTER’ campaign is unlikely to accelerate CC elimination in Norway but may reduce population-level ASR. Alternatively, targeting under- and never-screeners may both eliminate CC faster and lead to greater health benefits compared with vaccination-based interventions we considered.

中文翻译：

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挪威加快消除宫颈癌的疫苗接种和筛查策略：基于模型的分析

背景

专家针对维持人乳头瘤病毒（HPV）循环的年龄组提出了“更快”的概念。我们探讨了这些提案中的疫苗接种部分与基于宫颈癌 (CC) 筛查的干预措施对挪威年龄标准化发病率 (ASR) 和 CC 消除（<4 例/100,000 例）时间的影响。

方法

我们使用基于模型的方法来评估 HPV 疫苗接种和 CC 筛查场景，并与反映先前疫苗接种和筛查的现状场景进行比较。对于年龄 25-30 岁的人群，我们研究了 6 种疫苗接种方案，这些方案在当前特定人群的基础上逐步提高了疫苗接种覆盖率。每种疫苗接种方案都与三种不同筛查频率的筛查策略相结合。此外，我们还纳入了 4 种可提高筛查依从性的场景。人群和队列水平的结果包括 ASR、CC 的终生风险和阴道镜转诊。

结果

几种疫苗接种策略加上去强化的筛查频率降低了 ASR，但并没有加速 CC 的消除。提高筛查依从性的替代策略既可以加速消除，又可以改善 ASR。

结论

“更快”运动的疫苗接种部分不太可能加速挪威的 CC 消除，但可能会降低人口水平的 ASR。另外，与我们考虑的基于疫苗接种的干预措施相比，针对筛查不足和从未筛查者可能会更快地消除 CC，并带来更大的健康益处。