Discussing Cervical Cancer Screening Options: Outcomes to Guide Conversations Between Patients and Providers.

Holt, Hunter K

Kulasingam, Shalini

Sanstead, Erinn C

Alarid-Escudero, Fernando

Smith-McCune, Karen

Gregorich, Steven E

Silverberg, Michael J

Huchko, Megan J

Kuppermann, Miriam

Sawaya, George F

2020-10-01T15:20:48Z

2020-10-01T15:20:48Z

2020-07

2020-10-01T15:20:47Z

Purpose. In 2018, the US Preventive Services Task Force (USPSTF) endorsed three strategies for cervical cancer screening in women ages 30 to 65: cytology every 3 years, testing for high-risk types of human papillomavirus (hrHPV) every 5 years, and cytology plus hrHPV testing (co-testing) every 5 years. It further recommended that women discuss with health care providers which testing strategy is best for them. To inform such discussions, we used decision analysis to estimate outcomes of screening strategies recommended for women at age 30. Methods. We constructed a Markov decision model using estimates of the natural history of HPV and cervical neoplasia. We evaluated the three USPSTF-endorsed strategies, hrHPV testing every 3 years and no screening. Outcomes included colposcopies with biopsy, false-positive testing (a colposcopy in which no cervical intraepithelial neoplasia grade 2 or worse was found), treatments, cancers, and cancer mortality expressed per 10,000 women over a shorter-than-lifetime horizon (15-year). Results. All strategies resulted in substantially lower cancer and cancer death rates compared with no screening. Strategies with the lowest likelihood of cancer and cancer death generally had higher likelihood of colposcopy and false-positive testing. Conclusions. The screening strategies we evaluated involved tradeoffs in terms of benefits and harms. Because individual women may place different weights on these projected outcomes, the optimal choice for each woman may best be discerned through shared decision making.

10.1177_2381468320952409

2381-4683

2381-4683

https://hdl.handle.net/10161/21565

eng

SAGE Publications

MDM policy & practice

10.1177/2381468320952409

Pap smear

cervical cancer screening

high-risk HPV DNA testing

shared decision making

Discussing Cervical Cancer Screening Options: Outcomes to Guide Conversations Between Patients and Providers.

Journal article

Huchko, Megan J|0000-0002-4081-4768

2381468320952409

2

School of Medicine

Duke Cancer Institute

Duke Global Health Institute

Duke

Institutes and Centers

University Institutes and Centers

Institutes and Provost's Academic Units

Published

5