PRESENT EVIDENCE ON THE VALUE OF HPV TESTING FOR CERVICAL-CANCER SCREENING - A MODEL-BASED EXPLORATION OF THE (COST-)EFFECTIVENESS

Human papillomavirus (HPV) is the main risk factor for invasive cervic al cancer, High risk ratios are found in cross-sectional data on HPV p revalence. The question raised is whether this present evidence is suf ficient for making firm recommendations on HPV screening. A validated cervical cancer screening model was extended by adding HPV infection a s a possible precursor of cervical intraepithelial neoplasia (CIN). Tw o widely different model quantifications were constructed so that both were compatible with the observed HPV risk ratios. One model assumed a much longer duration of HPV infection before progressing to CIN and a higher sensitivity of the HPV test than the other. In one version of the model, the calculated mortality reduction from HPV screening was higher and the (cost-)effectiveness was much better than for Pap smear screening. in the other version, outcomes were the opposite, although the cost-effectiveness of the combined HPV + cytology test was close to that of Pap smear screening. Although small follow-up studies and s tudies with limited strength of design suggest that HPV testing may we ll improve cervical cancer screening, only large longitudinal screenin g studies on the association between HPV infection and the development of neoplasias can give outcomes that would enable a firm conclusion t o be made on the (cost-)effectiveness of HPV screening. Prospective st udies should address women aged 30-60 years.