Each year, more than 25,000 cases of invasive cancer attributable to human papillomavirus (HPV) infection occur in the United States;nearly 50% are cervical cancer, while the rest involve the oral cavity/oropharynx, anus, vulva, penis, and vagina. Collectively, these account for substantial morbidity and mortality, contribute to health disparities, and are associated with high economic costs. Advancements in HPV-related cancer epidemiology, coupled with new (e.g., HPV-16,-18 vaccines, HPV DNA testing) and emerging (e.g., biomarkers, therapeutic vaccines) technologies provide a remarkable opportunity to improve cancer prevention efforts. However, critical challenges remain with respect to clinical decision-making and prevention policy, pertaining to knowledge gaps and heterogeneities in the natural history of different cancers, uncertainties in HPV type distribution following HPV-16,-18 vaccination, and the real-world clinical effectiveness of emerging technologies. We propose to employ a decision-analytic approach, developing a flexible modeling framework that will allow us to synthesize the best available data;evaluate the health and economic consequences of alternative strategies;explore the uncertainty around their outcomes;explicitly quantify the tradeoffs associated with different approaches;and inform timely clinical and policy questions. By achieving our aims, we expect to have an impact on (1) the analytic methods of decision science;(2) the equitable distribution and rationale use of new technology;(3) the effectiveness of strategies for cancer prevention through clinical guidelines and national policies;(4) HPV-related cancer outcomes, including reduced incidence, enhanced quality of life, improved survival, and reduced disparities;and (5) the financial and economic profile of delivering cancer-related health services.

Public Health Relevance

Rapid advances in the fields of HPV-related cancer epidemiology and medical technology present opportunities to revolutionize the approach to cancer prevention in the U.S. but have outpaced the ability of policy makers to make informed decisions regarding optimal adoption of health interventions. In this project, we propose to develop a flexible modeling framework that will enable us to synthesize the best available data on HPV, provide insight into the comparative and cost-effectiveness of different strategies, and assist in informed public health and clinical decision-making with respect to prevention of HPV-related cancers.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Health Services Organization and Delivery Study Section (HSOD)
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Doriarose, Vincent P
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Harvard University
Public Health & Prev Medicine
Schools of Public Health
United States
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Burger, Emily A; Dyer, Michael A; Sy, Stephen et al. (2018) Development and Calibration of a Mathematical Model of Anal Carcinogenesis for High-Risk HIV-Infected Men. J Acquir Immune Defic Syndr 79:10-19
Pedersen, Kine; Burger, Emily A; Nygård, Mari et al. (2018) Adapting cervical cancer screening for women vaccinated against human papillomavirus infections: The value of stratifying guidelines. Eur J Cancer 91:68-75
Burger, Emily A; Kim, Jane J; Sy, Stephen et al. (2017) Age of Acquiring Causal Human Papillomavirus (HPV) Infections: Leveraging Simulation Models to Explore the Natural History of HPV-induced Cervical Cancer. Clin Infect Dis 65:893-899
Burger, Emily A; Pedersen, Kine; Sy, Stephen et al. (2017) Choosing wisely: a model-based analysis evaluating the trade-offs in cancer benefit and diagnostic referrals among alternative HPV testing strategies in Norway. Br J Cancer 117:783-790
Kim, Jane J; Burger, Emily A; Sy, Stephen et al. (2017) Optimal Cervical Cancer Screening in Women Vaccinated Against Human Papillomavirus. J Natl Cancer Inst 109:
Burger, Emily A; Sy, Stephen; Nygård, Mari et al. (2017) The Cost-Effectiveness of Cervical Self-Sampling to Improve Routine Cervical Cancer Screening: The Importance of Respondent Screening History and Compliance. Cancer Epidemiol Biomarkers Prev 26:95-103
Pedersen, Kine; Burger, Emily A; Sy, Stephen et al. (2016) Cost-effective management of women with minor cervical lesions: Revisiting the application of HPV DNA testing. Gynecol Oncol 143:326-333
Burger, Emily A; Lee, Kyueun; Saraiya, Mona et al. (2016) Racial and ethnic disparities in human papillomavirus-associated cancer burden with first-generation and second-generation human papillomavirus vaccines. Cancer 122:2057-66
Burger, Emily A; Sy, Stephen; Nygård, Mari et al. (2015) Too late to vaccinate? The incremental benefits and cost-effectiveness of a delayed catch-up program using the 4-valent human papillomavirus vaccine in Norway. J Infect Dis 211:206-15
Campos, Nicole G; Castle, Philip E; Wright Jr, Thomas C et al. (2015) Cervical cancer screening in low-resource settings: A cost-effectiveness framework for valuing tradeoffs between test performance and program coverage. Int J Cancer 137:2208-19

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