Discussing Cervical Cancer Screening Options: Outcomes to Guide Conversations Between Patients and Providers

To inform such discussions, we used decision analysis to estimate outcomes of screening strategies recommended for women at age 30.

Cervical cancer
Screening
Decision modeling
Authors

Holt HK

Kulasingam S

Sanstead EC

Alarid-Escudero F

Smith-McCune K

Gregorich SE

Silverberg M

Huchko MJ

Kuppermann M

Sawaya G

Published

August 19, 2020

Recommended citation

Holt HK, Kulasingam S, Sanstead EC, Alarid-Escudero F, Smith-McCune K, Gregorich SE, Silverberg M, Huchko MJ, Kuppermann M, Sawaya G Discussing Cervical Cancer Screening Options: Outcomes to Guide Conversations Between Patients and Providers. Medical Decision Making Policy & Practice, 2020;5(2):1-7.

   

Published in:

 

Abstract

 

Background

In 2018, the US Preventive Services Task Force (USPSTF) endorsed three strategies for cervical cancer screening in women ages 30 to 65: cytology every 3 years, testing for high-risk types of human papillomavirus (hrHPV) every 5 years, and cytology plus hrHPV testing (co-testing) every 5 years. It further recommended that women discuss with health care providers which testing strategy is best for them. To inform such discussions, we used decision analysis to estimate outcomes of screening strategies recommended for women at age 30.

 

Methods

We constructed a Markov decision model using estimates of the natural history of HPV and cervical neoplasia. We evaluated the three USPSTF-endorsed strategies, hrHPV testing every 3 years and no screening. Outcomes included colposcopies with biopsy, false-positive testing (a colposcopy in which no cervical intraepithelial neoplasia grade 2 or worse was found), treatments, cancers, and cancer mortality expressed per 10,000 women over a shorter-than-lifetime horizon (15-year).

 

Results

All strategies resulted in substantially lower cancer and cancer death rates compared with no screening. Strategies with the lowest likelihood of cancer and cancer death generally had higher likelihood of colposcopy and false-positive testing.

 

Conclusions

The screening strategies we evaluated involved tradeoffs in terms of benefits and harms. Because individual women may place different weights on these projected outcomes, the optimal choice for each woman may best be discerned through shared decision making.