Use of Risk-Based Cervical Screening Programs in Resource-Limited Settings

Authors

Rebecca B. Perkins, Boston University Chobanian and Avedisian School of Medicine/Boston Medical Center, Boston, MA, USA. Electronic address: rbperkin@bu.edu.
Debi L. Smith, National Cancer Institute, Bethesda, MD, USA.
Jose Jeronimo, National Cancer Institute, Bethesda, MD, USA.
Nicole G. Campos, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Julia C. Gage, National Cancer Institute, Bethesda, MD, USA.
Natasha Hansen, National Cancer Institute, Bethesda, MD, USA.
Ana Cecilia Rodriguez, National Cancer Institute, Bethesda, MD, USA.
Li C. Cheung, National Cancer Institute, Bethesda, MD, USA.
Didem Egemen, National Cancer Institute, Bethesda, MD, USA.
Brian Befano, Information Management Services Inc, 3901 Calverton Blvd Suite 200, Calverton, MD, USA.
Akiva P. Novetsky, Westchester Medical Center/New York Medical College, Valhalla, NY, USA.
Sandro Martins, University Hospital of Brasilia, Brasilia, Brazil.
Jayashree Kalpathy-Cramer, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Federica Inturrisi, National Cancer Institute, Bethesda, MD, USA.
Syed Rakin Ahmed, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02129, USA; Harvard Graduate Program in Biophysics, Harvard Medical School, Harvard University, Cambridge, MA 02115, USA; Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH 02139,USA.
Jenna Marcus, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
Nicolas Wentzensen, National Cancer Institute, Bethesda, MD, USA.
Silvia de Sanjose, National Cancer Institute, Bethesda, MD, USA; ISGlobal, Barcelona, Spain.
Mark Schiffman, National Cancer Institute, Bethesda, MD, USA.

Author Type(s)

Faculty

Journal Title

Cancer Epidemiology

First Page

102369

Document Type

Article

Publication Date

6-1-2023

Department

Obstetrics and Gynecology

Abstract

Cervical cancer screening and management in the U.S. has adopted a risk-based approach. However, the majority of cervical cancer cases and deaths occur in resource-limited settings, where screening and management are not widely available. We describe a conceptual model that optimizes cervical cancer screening and management in resource-limited settings by utilizing a risk-based approach. The principles of risk-based screening and management in resource limited settings include (1) ensure that the screening method effectively separates low-risk from high-risk patients; (2) directing resources to populations at the highest cancer risk; (3) screen using HPV testing via self-sampling; (4) utilize HPV genotyping to improve risk stratification and better determine who will benefit from treatment, and (5) automated visual evaluation with artificial intelligence may further improve risk stratification. Risk-based screening and management in resource limited settings can optimize prevention by focusing triage and treatment resources on the highest risk patients while minimizing interventions in lower risk patients.

Recommended Citation

Perkins, R. B., Smith, D. L., Jeronimo, J., Campos, N. G., Gage, J. C., Hansen, N., Rodriguez, A. C., Cheung, L. C., Egemen, D., Befano, B., Novetsky, A. P., Martins, S., Kalpathy-Cramer, J., Inturrisi, F., Ahmed, S. R., Marcus, J., Wentzensen, N., de Sanjose, S., & Schiffman, M. (2023). Use of Risk-Based Cervical Screening Programs in Resource-Limited Settings. Cancer Epidemiology, 84, 102369. https://doi.org/10.1016/j.canep.2023.102369