Epidemiological Modelling Of Cervical Cancer Control In High- & Low-Resource Settings

Iacopo BAUSSANO, International Agency for Research on Cancer, France
PLUMMER . 1 , RONCO G. 2 , DILLNER J. 3 , FRANCESCHI S. 1 , LAZZARATO . 1

1 Infection and Cancer Epidemiology Group, International Agency for Research on Cancer
2 Cancer Epidemiology Unit, CPO-Piemonte, Torino, Italy
3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

Purpose. Cervical cancer is the third most-common cancer in women worldwide, approximately 530,000 new cases have been estimated to occurred in year 2012. The incidence of cervical cancer is expected to increase to approximately 756,000 new cases by year 2035. Current changes of sexual behaviors in populations undergoing socio-economic transition are also expected to increase the risk of cervical cancer. In absence cancer control programs, most of the increase of cervical cancer incidence will occur in less developed countries.
We have developed a set of HPV transmission and cervical cancer progression models to support the introduction or modification of cervical cancer control programs both in high- and low resources settings. These models have been used in combination with biostatical analyses to provide an epidemiological interpretation of findings from field studies conducted in high- and low resources settings.
Methods. We calibrated and validated the models against large sets of data from high-resource settings. The validated models were subsequently adapted to a set of high- and low-resource countries. For each country we have simulated the introduction of vaccination combined or not with screening. We have assessed the impact of different levels of coverage, catch-up, and gender-neutral vaccination, across different populations.
Results. The effort necessary to obtain an effective control of HPV is directly dependent of the magnitude of the herd immunity effect, which is not constant across populations. Catch-up of older cohorts accelerates the impact of vaccination among older women and maximizes the chances of HPV elimination. Gender-neutral vaccination maximizes the herd immunity effect in populations with suboptimal vaccination coverage and improves the resilience of vaccination programs.
Conclusions. Epidemiological modeling is a flexible and informative approach to support the development and assessment of cervical cancer prevention methods in high- and low resources settings.
​Funding sources. FP7-HEALTH-2013, no. 603019 ; BMGF, no. OPP1053353​