Table 2.

Cumulative lifetime harms and benefits attributable to cervical cancer screening (compared with no screening) for a cohort of 100,000 women; average predictions of 55 parameter sets.

HarmsBenefits
Screening testTriageAgesScreening testsaPositive screening testsaColpo-scopiesbCIN2/3 detectedCIN3 detectedQuality of life lost from screening procedures (QALY)cCancers preventedCancer deaths preventedCancer morbidity prevented (QALY)Life-years gainedTotal QALY gainedd
No screening (reference)00000000000
Perfect screening adherencee
 CytologyLow colposcopy referralf25–70 y1,319,75348,8378,7856,7562,7314,8721,7516282,03013,34015,371
 CytologyHigh colposcopy referralf25–70 y1,319,85448,46030,3956,4742,6334,8261,7746362,05613,50415,560
 Cytology (25) and HPV testing (≥30)Cytology25–60 y698,93651,45560,5806,5652,1664,7691,9236712,22014,72816,948
 Cytology (25) and HPV testing (≥30)HPV16/18 and cytology25–60 y699,09151,22266,9616,5772,0854,7451,9506772,24914,93817,187
 HPV testingCytology25–60 y698,25068,50773,2966,5371,8895,6401,9676772,26415,06617,330
 HPV testingHPV16/18 and cytology25–60 y698,43568,20684,7566,5261,7735,6081,9956842,29415,28517,579
Imperfect screening adherenceg
 CytologyLow colposcopy referralf20–70 y1,141,91642,4207,8255,8942,5734,2351,5275511,77211,63413,407
 CytologyHigh colposcopy referralf20–70 y1,142,09242,12127,0125,6752,4904,1991,5565621,80611,84913,654
 Cytology (<30) and HPV testing (≥30)Cytology20–70 y847,79447,57733,8206,3002,3944,9861,7546282,03413,41515,449
 Cytology (<30) and HPV testing (≥30)HPV16/18 and cytology20–70 y848,36047,21143,9176,3192,2994,9501,8086452,09413,82915,923
 HPV testingCytology25–70 y676,39152,00741,1466,1672,3385,0501,7516282,03113,38015,411
 HPV testingHPV16/18 and cytology25–70 y677,12151,52556,1256,1552,1945,0011,8136452,09913,85615,955
 HPV testingCytology25–60 y591,62049,36739,9085,8932,2194,6661,7126041,98313,19015,173
 HPV testingHPV16/18 and cytology25–60 y592,27048,92254,6455,8872,0844,6211,7756222,05313,66815,720
Imperfect screening adherence sensitivity analysesh
 HPV testing (over-screening)Cytology20–70 y1,102,39096,47061,9686,7542,0267,5141,9246702,21714,69116,908
 HPV testing (over-screening)HPV16/18 and cytology20–70 y1,103,65695,75290,8546,6281,7857,4361,9776852,27615,09917,375
 HPV testing (under-screening)Cytology25–60 y437,69938,89332,7475,3852,2234,0371,5605581,81312,02113,833
 HPV testing (under-screening)HPV16/18 and cytology25–60 y438,11038,54744,5515,4262,1374,0051,6295791,88912,54814,437
  • Abbreviations: CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus; QALY, quality-adjusted life-years.

  • aIncludes only initial screening test; subsequent triage and follow-up tests are considered to be part of the management of screen-positive women. A positive screen test corresponds to an abnormal cytology test with cytology-based screening, or an HR HPV-positive test with HPV-based screening.

  • bIncludes all colposcopies from immediate referrals, follow-up of persistent HPV positives and persistent low-grade lesions, and follow-up post-CIN treatment. A single woman may experience multiple colposcopies during her management, so the number of colposcopies may be higher than the number of women with positive screen tests.

  • cQALY losses from attending screening, receiving an abnormal result, follow-up, and management of lesions.

  • dSum of cancer morbidity prevented and life-years gained from prevented cancers and cancer deaths. Does not include QALY losses from screening procedures.

  • ePerfect adherence: All women get screened exactly once every 3 years (cytology) or every 5 years (HPV testing).

  • fCytology-based screening scenarios with low colposcopy referral assume high-grade lesions have an age-specific 65%–97% probability of being immediately referred to colposcopy whereas low-grade lesions have only a 3%–9% age-specific probability of being immediately referred to colposcopy. Cytology-based screening scenarios with high colposcopy referral assume all abnormal cytology tests have a 65%–97% age-specific probability of being immediately referred to colposcopy.

  • gImperfect adherence: 53%–68% of women (depending on age) get screened at least once within a 3-year interval (cytology) or within a 5-year interval (HPV testing).

  • hOver-screening: 53%–68% of women (depending on age) get screened at least once within a 3-year interval, similar to the cytology-based imperfect screening scenario. Under-screening: 53%–68% of women (depending on age) get screened at least once within a 7-year interval.