Cervical cancer is the third most common malignancy in women worldwide. New information on the causal role of human papillomavirus (HPV) infection, and the availability of new cervical cancer screening options, raise important clinical and policy questions. The purpose of this project is to develop a Global Cervical Cancer Policy Model to address such questions in both developed and developing countries, in which differences in disease burden, health-care priorities, and economic resources will mandate consideration of different cancer control strategies. In the U.S., cervical cytology screening has reduced cancer incidence, however, has not been equally accessible to all groups of women. For women who are older, poor, or from select cultural minorities, there is a need to evaluate new strategies for increasing screening coverage. On the national level, the most pressing policy questions relate to the economic consequences of current screening programs and how to best utilize newer screening technologies, such as enhanced cytologic methods and HPV DNA testing. In developing countries, such as South and East Africa, the critical policy issue is how to realistically implement cervical cancer screening programs in the setting of competing health issues and limited healthcare and monetary resources. Recent clinical studies have shown promising results for less complex screening strategies, such as simple visual screening methods or HPV DNA testing followed by immediate treatment without colposcopic triage However, these noncytological screening strategies need to be formally evaluated to determine if they can be implemented and sustained for a cost acceptable to developing countries.
The specific aims of this project are: (1) To develop a probabilistic cervical cancer model incorporating new epidemiological data on the natural history of HPV; (2) To evaluate the health and economic consequences of alternative cervical cancer screening strategies in the U.S., focusing on subpopulations at particularly high-risk and readdressing optimal target ages, screening intervals and use of new technology; (3) To assess the cost-effectiveness of alternative cervical cancer screening and prevention strategies for previously unscreened women in South Africa and Zimbabwe, incorporating the impact of REV, and considering the health-infrastructure and per-capita health expenditure in each country. This project will bring together a team of diverse investigators with complementary areas of expertise to develop a comprehensive, state-of-the-art, Global Cervical Cancer Policy Model. The proposed analyses will provide important information to clinicians, public health providers, and policy makers in both the national and international arena.
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