Screenwide is a case-control study (2017−2021) including women with incident endometrial and ovarian cancers (EC and OC), BRCA1/2 and MMR pathogenic variant carriers, and age-matched controls from ...three centers in Spain. Participants completed a personal interview on their sociodemographic factors, occupational exposure, medication, lifestyle, and medical history. We collected biological specimens, including blood samples, self-collected vaginal specimens, cervical pap-brush samples, uterine specimens, and, when available, tumor samples. The planned analyses included evaluation of the potential risk factors for EC/OC; evaluation of molecular biomarkers in minimally invasive samples; evaluation of the cost-effectiveness of molecular tests; and the generation of predictive scores to integrate different epidemiologic, clinical, and molecular factors. Overall, 182 EC, 69 OC, 98 BRCA pathogenic variant carriers, 104 MMR pathogenic variant carriers, and 385 controls were enrolled. The overall participation rate was 85.7%. The pilot study using 61 samples from nine EC cases and four controls showed that genetic variants at the variant allele fraction > 5% found in tumors (n = 61 variants across the nine tumors) were detected in paired endometrial aspirates, clinician-collected cervical samples, and vaginal self-samples with detection rates of 90% (55/61), 79% (48/61), and 72% (44/61) by duplex sequencing, respectively. Among the controls, only one somatic mutation was detected in a cervical sample. We enrolled more than 800 women to evaluate new early detection strategies. The preliminary data suggest that our methodological approach could be useful for the early detection of gynecological cancers.
Background. Baseline information on human papillomavirus (HPV) prevalence and type distribution is highly desirable to evaluate the impact of prophylactic HPV vaccines in the near future. Methods. A ...meta-analysis was performed of studies published between 1995 and 2009 that used polymerase chain reaction or Hybrid Capture 2 for HPV detection in women with normal cytological findings. Results. The analysis included 194 studies comprising 1,016,719 women with normal cytological findings. The estimated global HPV prevalence was 11.7% (95% confidence interval, 11.6%–11.7%). Sub-Saharan Africa (24.0%), Eastern Europe (21.4%), and Latin America (16.1%) showed the highest prevalences. Age-specific HPV distribution presented with a first peak at younger ages (<25 years) and, in the Americas and Africa, a rebound at older ages (⩾45 years). Among the women with type-specific HPV data (n = 215,568), the 5 most common types worldwide were HPV-16 (3.2%), HPV-18 (1.4%), HPV-52 (0.9%), HPV-31 (0.8%), and HPV-58 (0.7%). Conclusions. Although the prevalence of HPV in women with normal cytological findings is high and variable across world regions, HPV types 16, 18, 31, 52, and 58 are consistently found among the 10 most common types in all of them. These results represent the most comprehensive assessment of HPV burden among women with normal cytological findings in the pre-HPV vaccination era worldwide.
Abstract Approximately 70% of cases of cervical cancer worldwide are caused by genotypes 16 and 18 of human papillomavirus (HPV), which is sexually transmitted. With the availability of an effective ...vaccine against these HPV types, there is real hope for reducing the global burden of cervical cancer in developing countries. Stakeholders faced with decisions about where to invest money to improve health must consider the burden of disease caused by cervical cancer relative to other priorities and the comparative benefits of different interventions. We conducted a series of analyses to obtain information for agencies drafting immunisation policy recommendations, financing coordination mechanisms, and country decision-makers on the benefits, cost requirements and cost-effectiveness of the HPV16,18 vaccine. We found that making an HPV16,18 vaccine accessible to 70% of young adolescent girls in 72 of the poorest countries, China, Thailand, and all of Latin America and the Caribbean, could prevent the future deaths of more than four million women vaccinated over the next decade. Provided the cost per vaccinated girl is less than $10–$25, adolescent HPV16,18 vaccination would be cost-effective even in relatively poor countries. Concerns about financial costs and affordability highlight the need for lowering vaccine prices, cost-efficient mechanisms for delivery of vaccinations to adolescents, and creative sources of financing.
Geographical widespread data on human papillomavirus (HPV) type-distribution are essential for estimating the impact of HPV-16/18 vaccines on cervical cancer and cervical screening programmes. ...Epidemiological studies employing a variety of HPV typing protocols have been collated in meta-analyses. HPV-16/18 is estimated to account for 70% of all cervical cancers worldwide, although the estimated HPV-16/18 fraction is slightly higher in more developed (72–77%) than in less developed (65–72%) regions. About 41–67% of high-grade squamous intraepithelial lesion (HSIL), 16–32% of low-grade squamous intraepithelial lesion (LSIL) and 6–27% of atypical squamous cells of undetermined significance (ASCUS) are also estimated to be HPV-16/18-positive, thus highlighting the increasing relative frequency of HPV-16/18 with increasing lesion severity. After HPV-16/18, the six most common HPV types are the same in all world regions, namely 31, 33, 35, 45, 52 and 58; these account for an additional 20% of cervical cancers worldwide.
•Quitting interventions are more effective and cost-effective at younger ages.•Integration of quitting interventions into LDCT screening is highly effective.•Combined strategies are more ...cost-effective than both approaches separately.•Both interventions should be considered as complementary strategies.•Findings could be generalizable to other industrialized countries.
Robust economic evaluations are needed to identify efficient strategies for lung cancer prevention that combine brief and intensive smoking cessation intervention programmes with screening using low-dose computed tomography (LDCT) at different ages, frequencies, and coverages. We aimed to assess the cost-effectiveness of smoking cessation approaches combined with lung cancer screening in the European context at a population level from a societal perspective.
A microsimulation model that describes the natural history of lung cancer and incorporates several prevention strategies was developed. Discounted lifetime QALYs and costs at a rate of 3% were used to calculate incremental cost-effectiveness ratios, defined as additional costs in 2017 Euros per QALY gained.
Smoking cessation interventions reduce the incidence of lung cancer by 8%-46% and are consistently more effective and cost-effective when starting at younger ages. Screening reduces lung cancer mortality by 1%-24% and is generally less effective and more costly than smoking cessation interventions. The most cost-effective strategy would be to implement intensive smoking cessation interventions at ages 35, 40 and 45, combined with screening every three years between the ages of 55 and 65.
Combining smoking cessation interventions with LDCT screening is a very attractive prevention strategy that substantially diminishes the burden of lung cancer. These combined prevention strategies, especially when providing several intensive interventions for smoking cessation at early ages, are more cost-effective than both approaches separately and allow for a more intensified LDCT without losing efficiency.
Highlights ► HPV vaccination of pre-adolescent girls is cost-effective. ► At US$400–500 per individual, male vaccination may be cost-effective if female uptake is <50%. ► Cost-effectiveness of ...screening requires re-evaluation in vaccinated populations. ► Primary HPV screening is a promising strategy in partially vaccinated populations.
INTRODUCCIÓN: Introducir la vacunación del Virus del Papiloma Humano (VPH) en un programa nacional de inmunización no es trivial y depende de múltiples factores tales como la carga de la enfermedad, ...la eficacia de la vacuna, el coste-efectividad o su viabilidad. Los análisis económicos son un componente común del proceso de decisión en los países industrializados. Sin embargo, aunque cada vez se utilizan más este tipo de análisis en los países menos desarrollados, la alta incidencia de cáncer de cuello de útero (CCU) es la que ha llevado a considerar la introducción de la vacuna del VPH.
OBJETIVO: Evaluar el impacto sanitario y económico de la vacunación contra los VPHs 16 y 18 en niñas preadolescentes y ayudar a la toma de decisiones en países en desarrollo
METODOLOGÍA: Se han llevado a cabo una serie de análisis utilizando dos modelos analíticos en función de los datos disponibles: modelo de microsimulación y modelo simple de cohortes.
CONCLUSIÓN: La vacunación contra los VPHs 16 y 18 se considera una estrategia efectiva para reducir tanto la carga en salud como económica producida por el CCU, pero el coste-efectividad depende en gran medida de algunas asunciones sobre las vacunas como la eficacia o la duración de la protección y sobretodo del coste, además de la capacidad de cada país para administrar la vacuna a niñas antes de las edades con mayor riesgo de infección.
BACKGROUND: Introducing Human Papillomavirus (HPV) vaccination in a national immunization programme is not straightforward and depends on multiple factors, including disease burden, vaccine effectiveness, cost-effectiveness and affordability of the vaccination program. The economic analyses are a common component of the decision process in industrialized countries. However, although cost-effectiveness analyses are increasingly used in less developed countries, the burden of cervical cancer has clearly led the consideration of the HPV vaccine introduction.
OBJECTIVE: To assess the health and economic impact of the HPV 16 and 18 vaccination of pre-adolescents girls and to assist decision makers in less developed countries.
METHODOLOGY: A series of analyses have been conducted using two models depending on the data available: micro-simulation model and simple cohort model.
CONCLUSION: HPV 16 and 18 vaccination would be considered an effective strategy to reduce the health and economic burden of cervical cancer, but the cost-effectiveness depends on some vaccine assumptions such as the efficacy and the duration of protection and mostly on cost, in addition to the ability of the countries to reach girls before the ages at the highest risk of infection.
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