PCN43 NEW CERVICAL CANCER SCREENING POLICY IN GERMANY - WHAT IS THE IMPACT ON THE BENEFIT-HARM BALANCE?

Abstract

In Germany, cervical cancer screening is moving from opportunistic annual Papanicolaou (Pap) cytology for women as of age 20 years to organized screening with 3-yearly co-testing using human papillomavirus testing (HPV) and Pap cytology for women as of age 35 years and annual Pap for women age 20-34 years. Our aim was to systematically evaluate the impact of the new cervical cancer screening policy on long-term benefits and harms. A Markov-state-transition model calibrated to the German epidemiological and clinical context of the disease was used to evaluate different screening strategies that differ by primary screening test (Pap cytology, HPV-testing), screening interval, age, and specific follow-up algorithms. German clinical and epidemiological data, and test accuracy data from international meta-analyses were incorporated. Predicted outcomes were reduction in cervical cancer incidence, and -mortality, total cases of positive test results, colposcopies, and conizations. Comprehensive sensitivity analyses were performed. For organized screening, 50-70% adherence rates were assumed. Compared with current opportunistic annual Pap screening the new screening policy including organized screening with 3-yearly HPV-Pap co-testing as of age 35 years and annual Pap for younger women would result in similar or greater benefits in terms of reduction in cervical cancer incidence and mortality. The model predicted substantial relative risk reductions (RRR) in total positive test results (RRR: 22%), total cases of colposcopies (RRR: 44%), and conizations (RRR: 8%) compared with organized annual Pap screening. Risk-adapted screening with increased intervals for women vaccinated against oncogenic HPV types would additionally reduce overdiagnosis and overtreatment. Based on our benefit-harm analysis, the new German screening policy for cervical cancer screening including HPV-Pap co-testing in women as of age 35 years reduces overtreatment, likely without loss in benefits. Risk-adapted screening strategies based on women’s screening history and vaccination status should be considered in future policy adaptations.