Benefits, harms, and cervical cancer elimination timing of human papillomavirus screening approaches tailored to birth cohort as a proxy for vaccination status in the United States: a comparative modeling study.

Screening recommendations in the United States have not been modified for women who have been vaccinated against human papillomavirus (HPV). Using 3 independent Cancer Intervention and Surveillance Modeling Network (CISNET) models (Policy1-Cervix, Harvard and STDSIM-MISCAN), we evaluated the impact of switching from 3-yearly cytology-based screening for ages 21-65 ("cytology alone") to primary-HPV-16/18 screening for ages 25-65 every 5-years ("standardized 5-yearly HPV screening"), or every 8-10 years for younger vaccinated cohorts ("tailored HPV screening"). Compared to cytology alone, switching to standardized 5-yearly HPV screening for all women would reduce total cervical cancer deaths over the period 2020-2099 by 9%-14% and total colposcopies by 15%-49%, and achieve cervical cancer elimination by 2030-2037, 4 years earlier than cytology screening alone. Compared to cytology alone, tailored HPV screening would reduce cervical cancer deaths over the period 2020-2099 by 2%-14%, colposcopies by 30%-59%, and achieve elimination by 2030-2040, 1-4-years earlier. In conclusion, primary HPV screening in all women would be associated with improved health outcomes and would reduce colposcopy referrals in the longer term compared to older, cytology approaches. Tailoring the HPV screening interval to vaccination status has potential to increase efficiencies and maintain effectiveness and elimination timing.