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Updated: May 13, 2026

An R-Based Landscape Validation of a Competing Risk Model

An R-Based Landscape Validation of a Competing Risk Model

Published on: September 16, 2022

Screening for cervical cancer: a modeling study for the US Preventive Services Task Force.

Shalini L Kulasingam¹, Laura J Havrilesky, Rahel Ghebre

¹Minnesota Evidence-Based Practice Center, University of Minnesota, Minneapolis, MN 55454, USA. kulas016@umn.edu

Journal of Lower Genital Tract Disease

|March 23, 2013

Summary

Cervical cancer screening starting in the early 20s offers a good balance of benefits and harms. Current guidelines, including cytology and human papillomavirus (HPV) testing, are supported by modeling studies.

Related Experiment Videos

Last Updated: May 13, 2026

An R-Based Landscape Validation of a Competing Risk Model

An R-Based Landscape Validation of a Competing Risk Model

Published on: September 16, 2022

Area of Science:

Gynecology
Preventive Medicine
Oncology

Background:

Cervical cancer screening guidelines aim to balance early detection with potential harms.
The US Preventive Services Task Force (USPSTF) posed key questions regarding screening initiation, cessation, and the comparative effectiveness of different strategies.

Purpose of the Study:

To determine optimal ages for initiating and ending cervical cancer screening.
To compare the benefits and harms of human papillomavirus (HPV) DNA testing combined with cytology (cotesting) versus cytology-only screening.

Main Methods:

A Markov model was updated to simulate clinical outcomes for various cervical cancer screening strategies.
Outcomes quantified included colposcopies, cancer incidence, and life expectancy.

Main Results:

Screening in adolescence yielded minimal benefits with significant harms (colposcopies).
Initiating screening in the early 20s presented a favorable balance of benefits and harms.
Continuing screening past age 65 showed minor life expectancy gains but substantial increases in colposcopies.
Cotesting every 5 years for women aged 30 and older, following cytology-only screening every 3 years, demonstrated fewer colposcopies and greater life expectancy gains compared to cytology-only screening.

Conclusions:

Modeling results support current USPSTF recommendations for cervical cancer screening ages and strategies.
The study highlights the trade-offs between screening intensity, age, and testing modalities.