A general concern exists that cervical cancer screening using human papillomavirus (HPV) testing may lead to considerable overtreatment. We evaluated the trade‐off between benefits and overtreatment among different screening strategies differing by primary tests (cytology, p16/Ki‐67, HPV alone or in combinations), interval, age and diagnostic follow‐up algorithms. A Markov state‐transition model calibrated to the Austrian epidemiological context was used to predict cervical cancer cases, deaths, overtreatments and incremental harm–benefit ratios (IHBR) for each strategy. When considering the same screening interval, HPV‐based screening strategies were more effective compared to cytology or p16/Ki‐67 testing (e.g., relative reduction in cervical cancer with biennial screening: 67.7% for HPV + Pap cotesting, 57.3% for cytology and 65.5% for p16/Ki‐67), but were associated with increased overtreatment (e.g., 19.8% more conizations with biennial HPV + Papcotesting vs. biennial cytology). The IHBRs measured in unnecessary conizations per additional prevented cancer‐related death were 31 (quinquennial Pap + p16/Ki‐67‐triage), 49 (triennial Pap + p16/Ki‐67‐triage), 58 (triennial HPV + Pap cotesting), 66 (biennial HPV + Pap cotesting), 189 (annual Pap + p16/Ki‐67‐triage) and 401 (annual p16/Ki‐67 testing alone). The IHBRs increased significantly with increasing screening adherence rates and slightly with lower age at screening initiation, with a reduction in HPV incidence or with lower Pap‐test sensitivity. Depending on the accepted IHBR threshold, biennial or triennial HPV‐based screening in women as of age 30 and biennial cytology in younger women may be considered in opportunistic screening settings with low or moderate adherence such as in Austria. In organized settings with high screening adherence and in postvaccination settings with lower HPV prevalence, the interval may be prolonged.

中文翻译：

---

减少在宫颈癌筛查中与过度诊断相关的过度治疗-奥地利基于模型的利益-危害分析。

人们普遍担心，使用人乳头瘤病毒（HPV）测试进行子宫颈癌筛查可能会导致严重的过度治疗。我们评估了不同筛查策略在收益和过度治疗之间的权衡，这些筛查策略因主要检查（细胞学，p16 / Ki-67，HPV单独或组合），间隔，年龄和诊断随访算法而异。根据奥地利流行病学背景校准的马尔可夫状态转变模型用于预测每种策略的子宫颈癌病例，死亡，过度治疗和递增的伤害受益比（IHBR）。考虑相同的筛查间隔时，与细胞学或p16 / Ki-67检测相比，基于HPV的筛查策略更有效（例如，每两年筛查宫颈癌相对减少：HPV + Pap共同检测为67.7％，细胞学为57.3％， 65。p16 / Ki-67为5％），但与过度治疗相关（例如，两年一次的HPV + Papcotesting与两年一次的细胞学检查相比，锥切术增加了19.8％）。每额外预防的癌症相关死亡以不必要的锥切测量的IHBRs为31（每五年一次Pap + p16 / Ki-67-triage），49（每三年一次Pap + p16 / Ki-67-triage），58（每三年一次HPV + Pap共同测试） ，66（每两年一次HPV + Pap共同测试），189（每年一次Pap + p16 / Ki-67-triage）和401（每年一次p16 / Ki-67测试）。随着筛查依从率的提高，IHBRs显着增加，而随着筛查开始年龄的降低，HPV发生率降低或巴氏试验敏感性降低，IHBR则略有增加。根据接受的IHBR阈值，30岁以下女性每两年或三年一次基于HPV的筛查以及年轻女性每两年一次的细胞学检查可考虑在依从性较低或中等的机会性筛查环境中进行，例如在奥地利。在筛查依从性较高的有组织环境和HPV患病率较低的疫苗接种后环境中，间隔时间可能会延长。