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Withdrawing low risk women from cervical screening programmes: mathematical modelling study

C Sherlaw-Johnson1, S Gallivan, D Jenkins

  • 1Clinical Operational Research Unit, Department of Mathematics, University College London, London WC1E 6BT. c.sherlaw-johnson@ucl.ac.uk

BMJ (Clinical Research Ed.)
|February 5, 1999
PubMed
Summary

Removing women early from cervical cancer screening programs could save resources but may slightly increase cancer incidence. Further studies are needed to confirm these findings for policy consideration.

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Area of Science:

  • Oncology
  • Public Health
  • Epidemiology

Background:

  • Cervical cancer screening programs aim to detect precancerous lesions early.
  • Current UK guidelines recommend screening up to age 64.
  • The impact of altering withdrawal ages from screening is not fully understood.

Purpose of the Study:

  • To evaluate the impact of early withdrawal policies from UK cervical cancer screening.
  • To assess resource utilization and cancer incidence under different withdrawal scenarios.

Main Methods:

  • Utilized a mathematical model of cervical precancerous lesion progression.
  • Incorporated human papillomavirus (HPV) infection, screening effects, and test accuracy.
  • Compared two withdrawal policies based on negative smears and HPV status.

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Main Results:

  • Early withdrawal from age 50 could save up to 25% on smear tests and 18% on colposcopies.
  • A potential increase of up to 2 invasive cervical cancer cases per 100,000 women annually is predicted.
  • Using HPV testing for withdrawal decisions had minimal impact on outcomes.

Conclusions:

  • Mathematical modeling systematically analyzes screening option consequences.
  • Early withdrawal policies may offer substantial resource savings.
  • Further audit studies are needed to confirm model forecasts before policy consideration.