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3. Benefits, harms and cost-effectiveness of cervical screening, triage and treatment strategies for women in the general population

Author

Simms, Kate T., Keane, Adam, Nguyen, Diep Thi Ngoc, Caruana, Michael, Hall, Michaela T., Lui, Gigi, Gauvreau, Cindy, Demke, Owen, Arbyn, Marc, Basu, Partha, Wentzensen, Nicolas, Lauby-Secretan, Beatrice, Ilbawi, Andre, Hutubessy, Raymond, Almonte, Maribel, De Sanjosé, Silvia, Kelly, Helen, Dalal, Shona, Eckert, Linda O., Santesso, Nancy, Broutet, Nathalie, and Canfell, Karen

Published
2023
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4. Benefits and harms of cervical screening, triage and treatment strategies in women living with HIV

Author

Hall, Michaela T., Simms, Kate T., Murray, John M., Keane, Adam, Nguyen, Diep T. N., Caruana, Michael, Lui, Gigi, Kelly, Helen, Eckert, Linda O., Santesso, Nancy, de Sanjose, Silvia, Swai, Edwin E., Rangaraj, Ajay, Owiredu, Morkor Newman, Gauvreau, Cindy, Demke, Owen, Basu, Partha, Arbyn, Marc, Dalal, Shona, Broutet, Nathalie, and Canfell, Karen

Published
2023
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7. Global review of COVID-19 mitigation strategies and their impact on cancer service disruptions

Author

Shah, Richa, Loo, Ching Ee, Hanna, Nader Mounir, Hughes, Suzanne, Mafra, Allini, Fink, Hanna, McFerran, Ethna, Garcia, Montse, Acharya, Suryakanta, Langselius, Oliver, Frick, Clara, Niyigaba, Jean, Lasebikan, Nwamaka, Steinberg, Julia, Sullivan, Richard, Bray, Freddie, Ilbawi, André Michel, Ginsburg, Ophira, Chiam, Karen, Cylus, Jonathan, Caruana, Michael, David, Michael, Hui, Harriet, Canfell, Karen, and Soerjomataram, Isabelle

Published
2024
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8. Bayesian calibration of simulation models: A tutorial and an Australian smoking behaviour model

Author

Wade, Stephen, Weber, Marianne F, Sarich, Peter, Vaneckova, Pavla, Behar-Harpaz, Silvia, Ngo, Preston J, Cressman, Sonya, Gartner, Coral E, Murray, John M, Blakely, Tony A, Banks, Emily, Tammemagi, Martin C, Canfell, Karen, and Caruana, Michael

Subjects
Statistics - Applications, Statistics - Computation, 62P20 (Primary) 62M09 (Secondary), G.3
Abstract

Simulation models of epidemiological, biological, ecological, and environmental processes are increasingly being calibrated using Bayesian statistics. The Bayesian approach provides simple rules to synthesise multiple data sources and to calculate uncertainty in model output due to uncertainty in the calibration data. As the number of tutorials and studies published grow, the solutions to common difficulties in Bayesian calibration across these fields have become more apparent, and a step-by-step process for successful calibration across all these fields is emerging. We provide a statement of the key steps in a Bayesian calibration, and we outline analyses and approaches to each step that have emerged from one or more of these applied sciences. Thus we present a synthesis of Bayesian calibration methodologies that cut across a number of scientific disciplines. To demonstrate these steps and to provide further detail on the computations involved in Bayesian calibration, we calibrated a compartmental model of tobacco smoking behaviour in Australia. We found that the proportion of a birth cohort estimated to take up smoking before they reach age 20 years in 2016 was at its lowest value since the early 20th century, and that quit rates were at their highest. As a novel outcome, we quantified the rate that ex-smokers switched to reporting as a 'never smoker' when surveyed later in life; a phenomenon that, to our knowledge, has never been quantified using cross-sectional survey data., Comment: 49 pages, 5 figures, 17 tables

Published
2022

17. Expenditure and resource utilisation for cervical screening in Australia

Author

Lew Jie-Bin, Howard Kirsten, Gertig Dorota, Smith Megan, Clements Mark, Nickson Carolyn, Shi Ju-Fang, Dyer Suzanne, Lord Sarah, Creighton Prudence, Kang Yoon-Jung, Tan Jeffrey, and Canfell Karen

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background The National Cervical Screening Program in Australia currently recommends that women aged 18–69 years are screened with conventional cytology every 2 years. Publicly funded HPV vaccination was introduced in 2007, and partly as a consequence, a renewal of the screening program that includes a review of screening recommendations has recently been announced. This study aimed to provide a baseline for such a review by quantifying screening program resource utilisation and costs in 2010. Methods A detailed model of current cervical screening practice in Australia was constructed and we used data from the Victorian Cervical Cytology Registry to model age-specific compliance with screening and follow-up. We applied model-derived rate estimates to the 2010 Australian female population to calculate costs and numbers of colposcopies, biopsies, treatments for precancer and cervical cancers in that year, assuming that the numbers of these procedures were not yet substantially impacted by vaccination. Results The total cost of the screening program in 2010 (excluding administrative program overheads) was estimated to be A$194.8M. We estimated that a total of 1.7 million primary screening smears costing $96.7M were conducted, a further 188,900 smears costing $10.9M were conducted to follow-up low grade abnormalities, 70,900 colposcopy and 34,100 histological evaluations together costing $21.2M were conducted, and about 18,900 treatments for precancerous lesions were performed (including retreatments), associated with a cost of $45.5M for treatment and post-treatment follow-up. We also estimated that $20.5M was spent on work-up and treatment for approximately 761 women diagnosed with invasive cervical cancer. Overall, an estimated $23 was spent in 2010 for each adult woman in Australia on cervical screening program-related activities. Conclusions Approximately half of the total cost of the screening program is spent on delivery of primary screening tests; but the introduction of HPV vaccination, new technologies, increasing the interval and changing the age range of screening is expected to have a substantial impact on this expenditure, as well as having some impact on follow-up and management costs. These estimates provide a benchmark for future assessment of the impact of changes to screening program recommendations to the costs of cervical screening in Australia.

Published
2012
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18. Impact of organised cervical screening on cervical cancer incidence and mortality in migrant women in Australia

Author

Aminisani Nayyereh, Armstrong Bruce K, Egger Sam, and Canfell Karen

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background Organised cervical screening, introduced in 1991, appears to have reduced rates of cervical cancer incidence and mortality in women in Australia. This study aimed to assess whether cervical cancer rates in migrant women in the state of New South Wales (NSW) showed a similar pattern of change to that in Australian-born women after 1991. Methods Data from the NSW Central Cancer Registry were obtained for females 15+ years diagnosed with invasive cervical cancer from 1973 to 2008 (N=11,485). We used joinpoint regression to assess annual percent changes (APC) in cervical cancer incidence and mortality before and after the introduction of organised cervical screening in 1991. Results APC in incidence fell more rapidly after than before 1991 (p Conclusions Like Australian-born women, most, but not all, groups of migrant women experienced an increased rate of fall in incidence of cervical cancer following introduction of organised cervical screening in 1991. An apparent rise in mortality in women in a ‘Rest of the World’ category might be explained by a recent rise in migration from countries with high cervical cancer incidence and mortality rates.

Published
2012
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19. Estimation of the costs of cervical cancer screening, diagnosis and treatment in rural Shanxi Province, China: a micro-costing study

Author

Shi Ju-Fang, Chen Jun-Feng, Canfell Karen, Feng Xiang-Xian, Ma Jun-Fei, Zhang Yong-Zhen, Zhao Fang-Hui, Li Rong, Ma Li, Li Zhi-Fang, Lew Jie-Bin, Ning Yan, and Qiao You-Lin

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Cost estimation is a central feature of health economic analyses. The aim of this study was to use a micro-costing approach and a societal perspective to estimate aggregated costs associated with cervical cancer screening, diagnosis and treatment in rural China. Methods We assumed that future screening programs will be organized at a county level (population ~250,000), and related treatments will be performed at county or prefecture hospitals; therefore, this study was conducted in a county and a prefecture hospital in Shanxi during 2008–9. Direct medical costs were estimated by gathering information on quantities and prices of drugs, supplies, equipment and labour. Direct non-medical costs were estimated via structured patient interviews and expert opinion. Results Under the base case assumption of a high-volume screening initiative (11,475 women screened annually per county), the aggregated direct medical costs of visual inspection, self-sampled careHPV (Qiagen USA) screening, clinician-sampled careHPV, colposcopy and biopsy were estimated as US$2.64,$7.49,$7.95,$3.90 and $5.76, respectively. Screening costs were robust to screening volume ( Conclusions Diagnostic costs were comparable to screening costs for high-volume screening but were greatly increased in lower-volume situations, which is a key consideration for the scale-up phase of new programs. The study’s findings will facilitate cost-effectiveness evaluation and budget planning for cervical cancer prevention initiatives in China.

Published
2012
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20. Evaluation of primary HPV-DNA testing in relation to visual inspection methods for cervical cancer screening in rural China: an epidemiologic and cost-effectiveness modelling study

Author

Kang Yoon-Jung, Ma Li, Simonella Leonardo, Ning Yan, Legood Rosa, Zhao Fang-Hui, Lew Jie-Bin, Canfell Karen, Shi Ju-Fang, Zhang Yong-Zhen, Smith Megan A, Chen Jun-Feng, Feng Xiang-Xian, and Qiao You-Lin

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background A new lower-cost rapid-throughput human papillomavirus (HPV) test (careHPV, Qiagen, Gaithersburg, USA) has been shown to have high sensitivity for the detection of high grade cervical intraepithelial neoplasia. Methods We assessed the outcomes and cost-effectiveness of careHPV screening in rural China, compared to visual inspection with acetic acid, when used alone (VIA) or in combination with Lugol's iodine (VIA/VILI). Using data on sexual behaviour, test accuracy, diagnostic practices and costs from studies performed in rural China, we estimated the cost-effectiveness ratio (CER) and associated lifetime outcomes for once-lifetime and twice-lifetime screening strategies, and for routine screening at 5-yearly, 10-yearly and IARC-recommended intervals. The optimal age range for once-lifetime screening was also assessed. Results For all strategies, the relative ordering of test technologies in reducing cervical cancer incidence and mortality was VIA (least effective); VIA/VILI; careHPV@1.0 pg/ml and careHPV@0.5 pg/ml (most effective). For once-lifetime strategies, maximum effectiveness was achieved if screening occurred between 35-50 years. Assuming a participation rate of ~70%, once-lifetime screening at age 35 years would reduce cancer mortality by 8% (for VIA) to 12% (for careHPV@0.5) over the long term, with a CER of US$557 (for VIA) to $959 (for careHPV@1.0) per life year saved (LYS) compared to no intervention; referenced to a 2008 GDP per capita in Shanxi Province of $2,975. Correspondingly, regular screening with an age-standardised participation rate of 62% (which has been shown to be achievable in this setting) would reduce cervical cancer mortality by 19-28% (for 10-yearly screening) to 43-54% (using IARC-recommended intervals), with corresponding CERs ranging from $665 (for 10-yearly VIA) to $2,269 (for IARC-recommended intervals using careHPV@1.0) per LYS. Conclusions This modelled analysis suggests that primary careHPV screening compares favourably to visual inspection screening methodologies in rural China, particularly if used as part of a regular screening program.

Published
2011
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21. Cervical cancer screening in Australia: modelled evaluation of the impact of changing the recommended interval from two to three years

Author

Howard Kirsten, Smith Megan, Clements Mark, Lew Jie-Bin, Creighton Prudence, Dyer Suzanne, Lord Sarah, and Canfell Karen

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background The National Cervical Screening Program in Australia currently recommends that sexually active women between the ages of 18-70 years attend routine screening every 2 years. The publically funded National HPV Vaccination Program commenced in 2007, with catch-up in females aged 12-26 years conducted until 2009; and this may prompt consideration of whether the screening interval and other aspects of the organized screening program could be reviewed. The aim of the current evaluation was to assess the epidemiologic outcomes and cost implications of changing the recommended screening interval in Australia to 3 years. Methods We used a modelling approach to evaluate the effects of moving to a 3-yearly recommended screening interval. We used data from the Victorian Cervical Cytology Registry over the period 1997-2007 to model compliance with routine screening under current practice, and registry data from other countries with 3-yearly recommendations to inform assumptions about future screening behaviour under two alternative systems for screening organisation - retention of a reminder-based system (as in New Zealand), or a move to a call-and-recall system (as in England). Results A 3-yearly recommendation is predicted to be of similar effectiveness to the current 2-yearly recommendation, resulting in no substantial change to the total number of incident cervical cancer cases or cancer deaths, or to the estimated 0.68% average cumulative lifetime risk of cervical cancer in unvaccinated Australian women. However, a 3-yearly screening policy would be associated with decreases in the annual number of colposcopy and biopsy procedures performed (by 4-10%) and decreases in the number of treatments for pre-invasive lesions (by 2-4%). The magnitude of the decrease in the number of diagnostic procedures and treatments would depend on the method of screening organization, with call-and-recall screening associated with the highest reductions. The cost savings are predicted to be of the order of A$10-18 M annually, equivalent to 6-11% of the total cost of the current program (excluding overheads), with call-and-recall being associated with the greatest savings. Conclusions Lengthening the recommended screening interval to 3 years in Australia is not predicted to result in increases in rates of cervical cancer and is predicted to decrease the number of women undergoing diagnostic and treatment procedures. These findings are consistent with a large body of international evidence showing that screening more frequently than every three years with cervical cytology does not result in substantial gains in screening effectiveness.

Published
2010
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30. Economic impact of using risk models for eligibility selection to the International lung screening Trial

Author

Cressman, Sonya, Weber, Marianne F., Ngo, Preston J., Wade, Stephen, Behar Harpaz, Silvia, Caruana, Michael, Tremblay, Alain, Manser, Renee, Stone, Emily, Atkar-Khattra, Sukhinder, Karikios, Deme, Ho, Cheryl, Fernandes, Aleisha, Yi Weng, Jing, McWilliams, Annette, Myers, Renelle, Mayo, John, Yee, John, Yuan, Ren, Marshall, Henry M, Fong, Kwun M, Lam, Stephen, Canfell, Karen, and Tammemägi, Martin C

Published
2023
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32. Building Capacity for Cervical Cancer Prevention in U.S.-Affiliated Pacific Islands: The Pacific Against Cervical Cancer Project

Author

Qin, Jin, primary, Scarinci, Isabel, additional, Lu, Enriquito, additional, Senkomago, Virginia, additional, Ngoc Nguyen, Diep Thi, additional, Abonales, Lesley, additional, Soin, Komal, additional, Edilyong, James, additional, Reichhardt, Martina, additional, Marfel, Maria, additional, Simms, Kate, additional, Canfell, Karen, additional, Maxwell, Kathryn, additional, Saraiya, Mona, additional, and Palafox, Neal, additional

Published
2024
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36. Point-of-care HPV DNA testing of self-collected specimens and same-day thermal ablation for the early detection and treatment of cervical pre-cancer in women in Papua New Guinea: a prospective, single-arm intervention trial (HPV-STAT)

Author

Vallely, Andrew J B, Saville, Marion, Badman, Steven G, Gabuzzi, Josephine, Bolnga, John, Mola, Glen D L, Kuk, Joseph, Wai, Malts, Munnull, Gloria, Garland, Suzanne M, Brotherton, Julia M L, Kelly-Hanku, Angela, Morgan, Christopher, Toliman, Pamela J, Kombati, Zure, Kariwiga, Grace, Babona, Delly, Tan, Grace, Simms, Kate T, Cornall, Alyssa M, Tabrizi, Sepehr N, Wand, Handan, Guy, Rebecca, Canfell, Karen, and Kaldor, John M

Published
2022
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37. Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence

Author

Freeman, Victoria, Hughes, Suzanne, Carle, Chelsea, Campbell, Denise, Egger, Sam, Hui, Harriet, Yap, Sarsha, Deandrea, Silvia, Caruana, Michael, Onyeka, Tonia C., IJzerman, Maarten J., Ginsburg, Ophira, Bray, Freddie, Sullivan, Richard, Aggarwal, Ajay, Peacock, Stuart J., Chan, Kelvin K.W., Hanna, Timothy P., Soerjomataram, Isabelle, O'Connell, Dianne L., Steinberg, Julia, and Canfell, Karen

Published
2022
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38. The risk of contracting SARS-CoV-2 or developing COVID-19 for people with cancer: A systematic review of the early evidence

Author

Carle, Chelsea, Hughes, Suzanne, Freeman, Victoria, Campbell, Denise, Egger, Sam, Caruana, Michael, Hui, Harriet, Yap, Sarsha, Deandrea, Silvia, Onyeka, Tonia C., IJzerman, Maarten J., Ginsburg, Ophira, Bray, Freddie, Sullivan, Richard, Aggarwal, Ajay, Peacock, Stuart J., Chan, Kelvin K.W., Hanna, Timothy P., Soerjomataram, Isabelle, O'Connell, Dianne L., Canfell, Karen, and Steinberg, Julia

Published
2022
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49. Lynch syndrome testing of colorectal cancer patients in a high-income country with universal healthcare: a retrospective study of current practice and gaps in seven australian hospitals

Author

Steinberg, Julia, Chan, Priscilla, Hogden, Emily, Tiernan, Gabriella, Morrow, April, Kang, Yoon-Jung, He, Emily, Venchiarutti, Rebecca, Titterton, Leanna, Sankey, Lucien, Pearn, Amy, Nichols, Cassandra, McKay, Skye, Hayward, Anne, Egoroff, Natasha, Engel, Alexander, Gibbs, Peter, Goodwin, Annabel, Harris, Marion, Kench, James G, Pachter, Nicholas, Parkinson, Bonny, Pockney, Peter, Ragunathan, Abiramy, Smyth, Courtney, Solomon, Michael, Steffens, Daniel, Toh, James Wei Tatt, Wallace, Marina, Canfell, Karen, Gill, Anthony, Macrae, Finlay, Tucker, Kathy, and Taylor, Natalie

Published
2022
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