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Strategies to accelerate the elimination of cervical cancer in British Columbia, Canada: a modelling study
Reka E Pataky1, Sara Izadi-Najafabadi2, Laurie W Smith2
1Cancer Control Research (Pataky, Izadi-Najafabadi, Smith, Peacock), BC Cancer; Canadian Centre for Applied Research in Cancer Control (Pataky, Izadi-Najafabadi); Women's Health Research Institute (Smith, Ogilvie), BC Women's Hospital and Health Centre, Vancouver, BC; Karmanos Cancer Institute (Gottschlich), Wayne State University, Detroit Mich.; Faculty of Medicine (Ionescu, Proctor), University of British Columbia; Cervix Screening Program (Ionescu, Proctor), BC Cancer; School of Population and Public Health (Ogilvie), University of British Columbia; Faculty of Health Sciences (Peacock), Simon Fraser University, Vancouver, BC rpataky@bccrc.ca.
Background:
To eliminate cervical cancer in Canada by 2040, defined as an annual age-standardized incidence rate (ASIR) lower than 4.0 per 100 000 women, the Canadian Partnership Against Cancer (CPAC) identified 3 priorities for action: increasing human papillomavirus (HPV) vaccine coverage, implementing HPV-based screening and increasing screening participation, and improving follow-up after abnormal screen results. Our objective was to explore the impact of these priorities on the projected time to elimination of cervical cancer in British Columbia.
Methods:
We used OncoSim-Cervical, a microsimulation model led and supported by CPAC and developed by Statistics Canada that simulates HPV transmission and the natural history of cervical cancer for the Canadian population. We updated model parameters to reflect BC's historical participation rates and program design. We simulated the transition to HPV-based screening and developed scenarios to explore the additional impact of achieving 90% vaccination coverage, 95% screening recruitment, 90% ontime screening, and 95% follow-up compliance. We projected cervical cancer incidence, ASIR, and year of elimination for the population of BC for 2023-2050.
Results:
HPV-based screening at current vaccination, participation, and follow-up rates can eliminate cervical cancer by 2034. Increasing on-time screening and follow-up compliance could achieve this target by 2031. Increasing vaccination coverage has a small impact over this time horizon.
Interpretation:
With the implementation of HPV-based screening, cervical cancer can be eliminated in BC before 2040. Efforts to increase screening participation and follow-up through this transition could potentially accelerate this timeline, but the transition from cytology- to HPV-based screening is fundamental to achieving this goal.
Insights
Cervical cancer elimination in British Columbia is achievable by 2034 with human papillomavirus (HPV)-based screening. Optimizing screening participation and follow-up could accelerate this goal to 2031.
Area of Science:
- Public Health
- Epidemiology
- Oncology
Background:
- Canada aims to eliminate cervical cancer by 2040, targeting an annual incidence rate below 4.0 per 100,000 women.
- Key priorities include increasing human papillomavirus (HPV) vaccination, implementing HPV-based screening, and improving follow-up care.
- This study examines the impact of these priorities on projected cervical cancer elimination timelines in British Columbia.
Purpose of the Study:
- To model the impact of HPV vaccination, screening, and follow-up strategies on cervical cancer elimination in British Columbia.
- To project the time to cervical cancer elimination under various intervention scenarios.
Main Methods:
- Utilized OncoSim-Cervical, a microsimulation model developed by Statistics Canada, to simulate HPV transmission and cervical cancer natural history.
- Updated model parameters with British Columbia-specific data and simulated a transition to HPV-based screening.
- Developed scenarios to assess the effects of achieving high vaccination coverage (90%), screening recruitment (95%), on-time screening (90%), and follow-up compliance (95%).
Main Results:
- HPV-based screening, at current vaccination and participation rates, can lead to cervical cancer elimination by 2034.
- Achieving 90% on-time screening and 95% follow-up compliance could advance elimination to 2031.
- Increased human papillomavirus (HPV) vaccination coverage showed a limited impact within the study's time horizon.
Conclusions:
- Cervical cancer elimination in British Columbia is feasible before 2040 with the adoption of HPV-based screening.
- Enhancing screening participation and follow-up compliance can expedite the elimination timeline.
- The transition to HPV-based screening is the most critical factor for achieving cervical cancer elimination.
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