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Review
. 2020 Dec 15;147(12):3305-3312.
doi: 10.1002/ijc.33178. Epub 2020 Jul 16.

Defining benchmarks for tolerable risk thresholds in cancer screening: Impact of HPV vaccination on the future of cervical cancer screening

Joseph E Tota  1   2   3 , Sandra D Isidean  2 , Eduardo L Franco  2
Affiliations
Review

Defining benchmarks for tolerable risk thresholds in cancer screening: Impact of HPV vaccination on the future of cervical cancer screening

Joseph E Tota et al. Int J Cancer. .

Abstract

The performance of cervical cancer screening will decline as a function of lower disease prevalence-a consequence of successful human papillomavirus (HPV) vaccination. Replacement of cytology with molecular HPV testing as the primary screening test and adoption of risk-based screening, with less intense screening of vaccinated individuals and initiated at older ages is expected to improve efficiency. However, policy officials may decide to further reduce or eliminate screening as the ratio of benefits to harms continues to decline. To evaluate the level of risk currently tolerated for different cancers in the United States (ie, for which clinical guidelines do not recommend secondary prevention though effective screening methods exist), we used US cancer registry data to compare incidence (2008-2012) and survival (1988-2011) associated with different cancers for which organized screening is recommended and not recommended. The most common cancer at ages 70 to 74 years (ie, age group with highest cancer incidence and reasonable life expectancy to consider screening in the US) satisfying Wilson and Jungner's classic screening criteria was vulvar cancer (incidence = 9/100 000 females). In comparison, the incidence of cervical cancer among females 65 years of age (the upper recommended age limit for screening) was 13 cases per 100 000 females (low as a reflection of effective screening), whereas 10-year survival was 66% (similar to vulvar cancer at 67%). Our approach of defining tolerable risk in cancer screening could help guide future decisions to modify cervical screening programs.

Keywords: HPV vaccination; cervical cancer; screening; tolerable risk.

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Conflict of interest statement

J. E. T. is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA but completed all work associated with this manuscript while employed at the National Cancer Institute. E. L. F. does not have a conflict of interest with the content of this manuscript but has occasionally served as a consultant to Merck and GSK on HPV vaccines, and to Roche and BD on HPV diagnostics. His institution received unrestricted grants from Merck and Roche. S. D. I. declared no potential conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Age‐specific incidence rates of various cancer sites, A, in women and B, in men according to United States SEER registry data (2008‐2012)
FIGURE 2
FIGURE 2
Relative survival by survival time (years) for various cancer sites, A, in women and B, in men according to United States SEER registry data (1988‐2011)
See this image and copyright information in PMC

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