Use of risk-based cervical screening programs in resource-limited settings

Rebecca B Perkins; Debi L Smith; Jose Jeronimo; Nicole G Campos; Julia C Gage; Natasha Hansen; Ana Cecilia Rodriguez; Li C Cheung; Didem Egemen; Brian Befano; Akiva P Novetsky; Sandro Martins; Jayashree Kalpathy-Cramer; Federica Inturrisi; Syed Rakin Ahmed; Jenna Marcus; Nicolas Wentzensen; Silvia de Sanjose; Mark Schiffman

doi:10.1016/j.canep.2023.102369

Use of risk-based cervical screening programs in resource-limited settings

Cancer Epidemiol. 2023 Jun:84:102369. doi: 10.1016/j.canep.2023.102369. Epub 2023 Apr 25.

Authors

Rebecca B Perkins¹, Debi L Smith², Jose Jeronimo², Nicole G Campos³, Julia C Gage², Natasha Hansen², Ana Cecilia Rodriguez², Li C Cheung², Didem Egemen², Brian Befano⁴, Akiva P Novetsky⁵, Sandro Martins⁶, Jayashree Kalpathy-Cramer⁷, Federica Inturrisi², Syed Rakin Ahmed⁸, Jenna Marcus⁹, Nicolas Wentzensen², Silvia de Sanjose¹⁰, Mark Schiffman²

Affiliations

¹ Boston University Chobanian and Avedisian School of Medicine/Boston Medical Center, Boston, MA, USA. Electronic address: rbperkin@bu.edu.
² National Cancer Institute, Bethesda, MD, USA.
³ Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁴ Information Management Services Inc, 3901 Calverton Blvd Suite 200, Calverton, MD, USA.
⁵ Westchester Medical Center/New York Medical College, Valhalla, NY, USA.
⁶ University Hospital of Brasilia, Brasilia, Brazil.
⁷ University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁸ 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.
⁹ Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
¹⁰ National Cancer Institute, Bethesda, MD, USA; ISGlobal, Barcelona, Spain.

PMID: 37105017
DOI: 10.1016/j.canep.2023.102369

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.

Keywords: Automated visual. evaluation; Cervical cancer prevention; HPV testing; Resource-limited settings; Risk-based screening.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Artificial Intelligence
Early Detection of Cancer / methods
Female
Humans
Mass Screening / methods
Papillomaviridae
Papillomavirus Infections* / diagnosis
Resource-Limited Settings
Uterine Cervical Neoplasms*

Grants and funding

T32 CA009168/CA/NCI NIH HHS/United States