When Less is More
Menée à partir d'un modèle mathématique incorporant des données américaines, cette étude estime le rapport coût-efficacité de différentes stratégies de dépistage du cancer du col de l'utérus chez les patientes vaccinées contre 2, 4 ou 9 types de papillomavirus humain
Kim et al. present the results of mathematic modeling to projected health and economic outcomes associated with screening of women vaccinated against human papillomavirus (HPV). The first-generation HPV vaccines protect against HPV16 and HPV18, the two types of HPV that cause approximately 70% of cervical cancer, and the second-generation HPV vaccine protects against HPV16, HPV18, and five additional carcinogenic HPV genotypes, seven types that cause approximately 90% of cervical cancer. All are US Food and Drug Administration (FDA) approved and recommended for use in the United States.
In this mathematic simulation, girls were vaccinated at the age of 12 years, an age at which the vast majority have not started to have sex and therefore are unexposed to HPV, the most common sexually transmitted infection. Women who were vaccinated at age 12 years in 2007, the year that one of the first-generation vaccines was FDA approved and recommended by the ACIP, are now just reaching the age of 21 years, the age at which routine screening in the general population in the United States is recommended to begin. Given that optimal cervical cancer screening in HPV-vaccinated populations remains unresolved, it is therefore timely to ask the questions of who, how, and when to screen in HPV-vaccinated populations. To put these questions into perspective, these HPV-vaccinated cohorts of women have a lifetime risk of cervical cancer before screening is less than or equal to risk for previous cohorts of women who have undergone a lifetime of high-quality screening.
Kim et al. found that those women …
Journal of the National Cancer Institute , éditorial en libre accès, 2017