Strategies to accelerate the elimination of cervical cancer in British Columbia, Canada: a modelling study.

IF 9.4 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Reka E Pataky, Sara Izadi-Najafabadi, Laurie W Smith, Anna Gottschlich, Diana Ionescu, Lily Proctor, Gina S Ogilvie, Stuart Peacock
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引用次数: 0

Abstract

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.

在加拿大不列颠哥伦比亚省加速消除宫颈癌的战略:一项模型研究。
背景:为了在 2040 年之前消除加拿大的宫颈癌(定义为每 10 万名妇女的年年龄标准化发病率 (ASIR) 低于 4.0),加拿大抗癌合作组织 (CPAC) 确定了 3 项优先行动:提高人类乳头瘤病毒 (HPV) 疫苗的覆盖率、实施基于 HPV 的筛查并提高筛查参与率,以及改善筛查结果异常后的随访。我们的目标是探讨这些优先事项对不列颠哥伦比亚省消除宫颈癌的预计时间的影响:我们使用了 OncoSim-Cervical,这是一个由 CPAC 领导和支持、加拿大统计局开发的微观模拟模型,该模型模拟了 HPV 在加拿大人口中的传播情况和宫颈癌的自然病史。我们更新了模型参数,以反映不列颠哥伦比亚省的历史参与率和计划设计。我们模拟了向基于 HPV 的筛查过渡的过程,并制定了一些方案来探讨实现 90% 疫苗接种覆盖率、95% 筛查招募率、90% 按时筛查率和 95% 随访依从率所带来的额外影响。我们预测了 2023-2050 年不列颠哥伦比亚省人口的宫颈癌发病率、ASIR 和消除年:结果:按照目前的疫苗接种率、参与率和随访率,基于 HPV 的筛查可在 2034 年消除宫颈癌。提高按时筛查率和随访率可在 2031 年实现这一目标。提高疫苗接种覆盖率对这一时间范围的影响较小:随着 HPV 筛查的实施,不列颠哥伦比亚省可在 2040 年前消除宫颈癌。通过这一转变提高筛查参与率和随访率的努力有可能加快这一时间表的实现,但从细胞学筛查向基于 HPV 的筛查转变是实现这一目标的基础。
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来源期刊
Canadian Medical Association journal
Canadian Medical Association journal 医学-医学:内科
CiteScore
8.30
自引率
4.10%
发文量
481
审稿时长
4-8 weeks
期刊介绍: CMAJ (Canadian Medical Association Journal) is a peer-reviewed general medical journal renowned for publishing original research, commentaries, analyses, reviews, clinical practice updates, and editorials. Led by Editor-in-Chief Dr. Kirsten Patrick, it has a significant impact on healthcare in Canada and globally, with a 2022 impact factor of 17.4. Its mission is to promote knowledge vital for the health of Canadians and the global community, guided by values of service, evidence, and integrity. The journal's vision emphasizes the importance of the best evidence, practice, and health outcomes. CMAJ covers a broad range of topics, focusing on contributing to the evidence base, influencing clinical practice, and raising awareness of pressing health issues among policymakers and the public. Since 2020, with the appointment of a Lead of Patient Involvement, CMAJ is committed to integrating patients into its governance and operations, encouraging their content submissions.
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