scholarly journals Impact of Delaying Effective and Cost-Effective Policy Decisions: An Example From Cervical Cancer Prevention in Norway

2022 ◽  
Vol 7 (1) ◽  
pp. 238146832110710
Author(s):  
Allison Portnoy ◽  
Mari Nygård ◽  
Lill Trogstad ◽  
Jane J. Kim ◽  
Emily A. Burger

Introduction. Delayed implementation of evidence-driven interventions has consequences that can be formally evaluated. In Norway, programs to prevent cervical cancer (CC)—screening and treatment of precancerous lesions and prophylactic vaccination against human papillomavirus (HPV) infection—have been implemented, but each encountered delays in policy implementation. To examine the effect of these delays, we project the outcomes that would have been achieved with timely implementation of two policy changes compared with the de facto delays in implementation (in Norway). Methods. We used a multimodeling approach that combined HPV transmission and cervical carcinogenesis to estimate the health outcomes and timeline for CC elimination associated with the implementation of two CC prevention policy decisions: a multicohort vaccination program of women up to age 26 years with bivalent vaccine in 2009 compared with actual “delayed” implementation in 2016, and a switch from cytology to primary HPV-based testing in 2015 compared with “delayed” rollout in 2020. Results. Timely implementation of two policy changes compared with current Norwegian prevention policy timeline could have averted approximately 970 additional cases (range of top 10 sets: 830–1060) and accelerated the CC elimination timeline by around 4 years (from 2039 to 2035). Conclusions. If delaying implementation of effective and cost-effective interventions is being considered, the decision-making process should include quantitative analyses on the effects of delays.

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Rousseau ◽  
M Massetti ◽  
S Barre ◽  
H Leleu ◽  
J Gaillot-de Saintignon

Abstract Background The National Cancer Institute (INCa) undertook the evaluation of the expected impact of HPV vaccination in the context of the recent marketing of nonavalent vaccine (Gardasil®9) and the implementation of organized screening (OS) of cervical cancer (CC) in France. Methods The study is based on a microsimulation model that replicates the natural history of CC. A cohort of 14-year-old women is generated and followed until death. Others HPV-infection related diseases (condyloma, anal cancer, penile cancer and oropharynx cancer) are not modelled. Different strategies were compared with the current vaccination coverage rate (VCR) of 21.4% (2017): impact of increased VCR alone and increased VCR combined with correction of inequalities (CI). Results are presented according to two hypotheses for the duration of protection offered by the vaccine (limited to 20 years and lifelong) and according to two hypotheses for price of the vaccine (French price and average European prices). Results The incremental cost-effectiveness ratio (ICER) was less than 15 000 euros per QALY (quality-adjusted life year) in all the assessed strategies. For each 14-year-old women cohort, 85% VCR with CI would prevent at least: 2 546 conations, 2 347 precancerous lesions CIN 2 / 3 diagnosed, 377 CCs, 139 deaths per CC (20 years vaccine protection). Scenarios based on increasing VCR with CI are the most cost-effective. Conclusions The study quantifies the increased risk of CC-related outcomes associated with current sub-optimal VCR and the possible investment to implement actions in order to improve the efficiency of the current strategies and tackle health inequalities (communication campaign, actions toward underserved women). Key messages Improving HPV vaccination uptake is a cost-effective measure, even considering only the cervical cancer prevention. Including health inequalities participation in modeling is crucial as underserved women are both less vaccinated and screened.


2020 ◽  
Vol 18 (6) ◽  
pp. 98-108
Author(s):  
N. V. Zarochentseva ◽  
O. I. Trushina ◽  
E. G Novikova ◽  
I. I. Baranov ◽  
P. D. Lopukhov ◽  
...  

Relevance. Cervical cancer (CC) continues to be the focus of attention of oncologists all over the world due to the fact that the incidence of it over the past decades has not tended to decrease. The steady increase in morbidity, high mortality rates, and the tendency to «rejuvenate» the disease, the relatively low detection rate of the early stages of the disease due to poor results of cytological screening predetermine the search for new scientifically based approaches to solving cervical cancer problems. A promising direction for the prevention of squamous cell carcinoma and adenocarcinoma associated with human papillomavirus (HPV) is prophylactic vaccination against HPV, the need for which is due to the role of HPV infection in carcinogenesis processes.The aim of this article is to summarize the currently available data on advances in the prevention of precancerous lesions and cervical cancer, primarily through vaccination against HPV infection.Conclusions. The creation of vaccines for the prevention of oncogenic HPV types is a significant achievement in the biomedical research area. The successful development of a group of vaccines, which can confidently be called the vaccines of the 21st century, gives us hope that modern medicine has the potential to reduce population cancer risk and reduce the likelihood of early onset of cervical cancer. Demonstration of the efficacy and feasibility of routine HPV vaccination programs in a number of countries demonstrates encouraging progress in solving cervical cancer problems. Vaccination against HPV will not only ensure epidemiological well-being, but also lead to a decrease in morbidity and mortality from such a terrible complication of human papillomavirus infection – cervical cancer.


2020 ◽  
Vol 25 (4) ◽  
pp. 54-56
Author(s):  
Georgeta Gînfălean

Abstract Considering actual SARS-COV 2 pandemic, the comfort and time of the female patient’ trend is to minimize the time spent in the doctor’s office, so that auto-testing is a solving problem in this context. This paper aims at the importance of self-collected urine and vaginal samples, since actual studies are showing that is a complementary method in HPV-testing and a screening method for prevention of cervical cancer. Genital HPV infection is responsible for approximately 99% of cervical cancers, and is considered a sexually transmitted disease. Given that eight out of ten patients have at least one episode of HPV infection in their lifetime, there is a need for a method of early detection of genital HPV infection. Cervical cancer is the second type of diagnosed cancer in the rank of genital cancers and the third leading cause of cancer death among the female population. In Romania, the frequency of cervical cancer and mortality caused by this type of cancer remains high. In 2018 Globocan, it was mentioned that the occurrence of cervical cancer in Romania was 8.6%, and the mortality was 19.5/10,000 women. Worldwide, the following have been implemented: primary prevention programmes (via immunization) and secondary prevention programmes – traditional cytological testing, to which co-tests have been added. In the co-testing sector, there has been found with an updated visa – the self-harvesting test, being considered a complementary and innovative method in genital HPV testing, which aims to: identify the presence of highly oncogenic HPV strains with a marked sensitivity. Self-harvesting testing aims to: signal the presence of highly oncogenic strains, extrapolation can lead to early identification of the number of cases of precancerous lesions of the cervix and implicitly of cervical cancer.


2016 ◽  
Vol 126 (4) ◽  
pp. 175-178
Author(s):  
Gustaw Chołubek ◽  
Krzysztof Wiktor ◽  
Karolina Małek ◽  
Dorota Robak-Chołubek

Abstract Introduction. HPV infection is one of the most common type of sexually transmitted infections and it is a significant epidemiological problem all over the world. The risk of infection persistence and its progression to pathological, precancerous lesions depends on HPV type. Vaccinations against HPV virus are one of the elements of the prophylactic program and allow for early detection of cervical cancer. Aim. Aim of the study was analysis of awareness of problems of human papillomavirus infections and cervical cancer prevention, including vaccinations against HPV among female students commencing studies in Lublin. Material and methods. The research group included 400 women selected at random, all starting their studies at five universities in Lublin. The research group was supposed to show some general knowledge of the problem of cervical cancer among young women. It was also to define how many of them benefited from the prophylaxis of getting a vaccination against HPV. The scientific tool was individually elaborated survey questionnaire. Obtained study results were then subject to statistical analysis. Results. The majority of respondents were not vaccinated against HPV – only 2.5% of the surveyed confirmed that they had been vaccinated. The surveyed students most frequently evaluated their knowledge on prevention of HPV cervical cancer as poor. The surveyed who admitted having information about HPV and cervical cancer prophylaxis during their classes at school significantly more frequently had high level of knowledge than women who claimed not to obtain such information at school (p=0.002). Conclusions. It might make sense to conduct planned comparative studies in the centers practicing population vaccinations among girls aged 12-13 and not practicing such primary prophylaxis with cytological follow-ups. It may allow to elaborate the effective model of cervical cancer prophylaxis based on early educational activities, both on primary and secondary prophylaxis.


2020 ◽  
Vol 26 (18) ◽  
pp. 2073-2086
Author(s):  
Saule Balmagambetova ◽  
Andrea Tinelli ◽  
Ospan A. Mynbaev ◽  
Arip Koyshybaev ◽  
Olzhas Urazayev ◽  
...  

High-risk human papillomavirus strains are widely known to be the causative agents responsible for cervical cancer development. Aggregated damage caused by papillomaviruses solely is estimated in at least 5% of all malignancies of the human body and 16% in cancers that affect the female genital area. Enhanced understanding of the complex issue on how the high extent of carcinogenicity is eventually formed due to the infection by the Papoviridae family would contribute to enhancing current prevention strategies not only towards cervical cancer, but also other HPV associated cancers. This review article is aimed at presenting the key points in two directions: the current cervical cancer prevention and related aspects of HPV behavior. Virtually all applied technologies related to HPV diagnostics and screening programs, such as HPV tests, colposcopy-based tests (VIA/VILI), conventional and liquid-based cytology, currently available are presented. Issues of availability, advantages, and drawbacks of the screening programs, as well as vaccination strategies, are also reviewed in the article based on the analyzed sources. The current point of view regarding HPV is discussed with emphasis on the most problematic aspect of the HPV family concerning the observed increasing number of highly carcinogenic types. Present trends in HPV infection diagnostics throughout the human fluids and tissues are also reported, including the latest novelties in this field, such as HPV assay/self-sample device combinations. Besides, a brief outline of the related prevention issues in Kazakhstan, the leading country of Central Asia, is presented. Kazakhstan, as one of the post-soviet middle-income countries, may serve as an example of the current situation in those terrains, concerning the implementation of globally accepted cervical cancer prevention strategies. Along with positive achievements, such as the development of a nationwide screening program, a range of drawbacks is also analyzed and discussed.


BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e050113
Author(s):  
Sneha Sethi ◽  
Brianna Poirier ◽  
Karen Canfell ◽  
Megan Smith ◽  
Gail Garvey ◽  
...  

RationaleIndigenous peoples carry a disproportionate burden of infectious diseases and cancers and are over-represented among the socially disadvantaged of most countries. Human papillomavirus (HPV) is a risk factor and causative agent of cervical, oropharyngeal and other cancers. Recent literature shows evidence of Indigenous populations being at increased risk of HPV infections and its associated cancers.ObjectiveThis is a qualitative systematic review. The objective of this study was to explore the experiences and barriers Indigenous women face in relation to HPV awareness, knowledge and cervical screening, in order to better understand factors that may mitigate against or facilitate prevention efforts for HPV infection and associated cancers.MethodsTwo investigators independently searched MEDLINE, PubMed, SCOPUS and Web of Science databases (for articles published from inception until 30 June 2020) using a prespecified search strategy to identify qualitative studies on narratives of Indigenous women regarding HPV infection awareness, knowledge and cervical screening, across all geographic and income-level settings. Using a ‘meta-study’ approach, a social ecological model of cervical screening, infection and associated cancer prevention among Indigenous populations was formulated.ResultsFive core themes were identified and formulated within the social ecological model; intrapersonal factors, interpersonal factors, institutional/organisational factors, sociocultural/community factors and public policy. These collectively formed the proposed social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women. This model has been synthesised by taking into account personal stories of Indigenous women and healthcare workers, thus offering a more nuanced, organised, structured and culturally sensitive approach to policy translation.ConclusionThe social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women offers a holistic and practical approach for Indigenous health policy makers. It clearly addresses the high risk of Indigenous populations at a global level in experience of both HPV infection and HPV-related cancers.PROSPERO registration numberCRD42020207643.


2020 ◽  
Author(s):  
Ping Li ◽  
Qing Liu ◽  
Wei Li ◽  
Zhou Liu ◽  
Baoling Xing ◽  
...  

Abstract Background: Human papillomavirus (HPV) infection is the main cause of precancerous lesions and cervical cancer in women. To determine the epidemiological characteristics as well as the relationship between the HPV genotype and cytology test results among women, we retrospectively collected and analyzed the data from Zhoupu District hospital in Shanghai, China.Methods: We made a retrospective analysis of human papillomavirus prevalence rate of 23,724 women between 2014 and 2019 in the District Zhoupu of Shanghai City in China. Their cervical exfoliations were collected. HPV genotype testing was performed using a commercial kit designed to detect 21 HPV subtypes including 15 high-risk HPV subtypes(16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66 ,68) and 6 low-risk HPV subtypes(6, 11, 42, 43, 44 and 81). And the thinPrep cytological test (TCT) was also performed at the same time.Results: Among all 23,724 cases, 3,816 (16.08%) women were infected with HPV. HPV52 (3.19%), HPV58 (2.47%) and HPV16 (2.34%) had higher prevalence. 3,480(91.20%) single-type infections were more common than 336(8.8%) multiple-type infections. Single-type infection was more frequently seen in women aged 50–60 years (16.63%) and <30 years (15.37%), and multiple-type infection was more common in those aged >= 60 (2.67%). Significant differences in secular trends from 2014 to 2019 were observed for subtypes HPV52, 58 and 16.HPV positive rates of women changed significantly along with the time period from 2014 to 2019.Among 4,502 TCT positive women, 15 (4.04%), 125 (2.64%) ,159 (1.54%), 4,202(17.71%) and 1(0.004%) had atypical squamous cells (ASC), high-grade squamous intraepithelial lesions (HSIL), low-grade squamous intraepithelial lesions (LSIL), atypical glandular cells (AGC) and cervical adenocarcinoma respectively. The HPV infection rates were 66.08%, 63.99%, 115.20%, 119.50%, and 31.72% for NILM, AGCs, HSILs LSILs and ASCs, respectively.Conclusions: HPV and TCT screening were a key step in the secondary prevention of cervical cancer. Further tracking the results of HPV and TCT was an important clinical strategy for the treatment of cervical precancerous lesions. The widespread use of preventive HPV vaccines can significantly reduce the incidence of pre-neoplastic and neoplastic cervical lesions.


Molecules ◽  
2018 ◽  
Vol 23 (9) ◽  
pp. 2334 ◽  
Author(s):  
Ying-Qi Wang ◽  
Jian-Liang Lu ◽  
Yue-Rong Liang ◽  
Qing-Sheng Li

Cervical cancer is the fourth most common gynecological cancer worldwide. Although prophylactic vaccination presents the most effective method for cervical cancer prevention, chemotherapy is still the primary invasive intervention. It is urgent to exploit low-toxic natural anticancer drugs on account of high cytotoxicity and side-effects of conventional agents. As a natural product, (-)-epigallocatechingallate (EGCG) has abilities in anti-proliferation, anti-metastasis and pro-apoptosis of cervical cancer cells. Moreover, EGCG also has pharmaceutical synergistic effects with conventional agents such as cisplatin (CDDP) and bleomycin (BLM). The underlying mechanisms of EGCG suppressive effects on cervical cancer are reviewed in this article. Further research directions and ambiguous results are also discussed.


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