Cervical cancer screening program based on primary DNA-HPV testing in a Brazilian city: a cost-effectiveness study...

Area of Science:

• Oncology
• Public Health
• Molecular Diagnostics

Background:

• Cervical cancer is a significant health issue in Brazil, with many cases diagnosed at advanced stages.
• High-risk human papillomavirus (hr-HPV) infection is causally linked to cervical precancerous lesions and cancer.
• DNA-HPV testing offers higher sensitivity than cytology, supporting its use as a primary screening method.

Purpose of the Study:

• To describe the design and implementation of a Cervical Cancer Screening Program (CCSP-HPV) utilizing primary DNA-HPV testing in Indaiatuba City, Brazil.
• To outline strategies for achieving high population coverage (80%) for cervical cancer screening.
• To establish a protocol for cost-effectiveness analysis of the new screening program.

Main Methods:

• The CCSP-HPV program screens women aged 25-64 within the public health system every five years using a DNA-HPV test detecting 14 hr-HPV types, including HPV-16/18.
• Positive HPV-16/18 results lead to colposcopy; other hr-HPV types trigger cytology, with abnormalities referred for colposcopy.
• A Markov model will compare the cost-effectiveness of the DNA-HPV primary screening program against previous cytology-based screening.

Main Results:

• The program aims for 80% coverage in its first round, representing a substantial increase over opportunistic screening.
• The DNA-HPV test identifies 14 high-risk HPV types, with specific pathways for HPV-16/18 positive and other hr-HPV positive results.
• Histopathologic evaluation will be standardized with pathologist review and p16 immunohistochemistry.

Conclusions:

• The CCSP-HPV program represents a significant advancement in public health for combating cervical cancer in Brazil.
• Achieving 80% screening coverage has the potential to dramatically alter the cervical cancer landscape.
• The program provides a modern screening approach, and its cost-effectiveness data will inform similar public health decisions globally.