programas cribado cancer

Nota bibliográfica cribado c cérvix 2013-07/08

Mullins R, Coomber K, Broun K, Wakefield M. Promoting cervical screening after introduction of the human papillomavirus vaccine: the effect of repeated mass media campaigns. Journal of Medical Screening 2013 March 01;20(1):27-32. DOI:10.1177/0969141313478588.

Conclusions A well-researched and carefully pretested television advertising campaign with accurate, actionable messages can elicit appropriate screening behaviour among some of the appropriate groups even in a changed environment of complex, and potentially competing, messages.

Castanon A, Leung VM, Landy R, Lim AW, Sasieni P. Characteristics and screening history of women diagnosed with cervical cancer aged 20-29 years. Br J Cancer 2013 Jul 9;109(1):35-41. DOI:10.1038/bjc.2013.322; PMID:23820257.

Conclusion:Cervical cancer at age 20-24 years is rare. Most cancers in women under age 30 years are screen detected as microinvasive cancer.

Tabuchi T, Hoshino T, Nakayama T, Ito Y, Ioka A, Miyashiro I, et al. Does removal of out-of-pocket costs for cervical and breast cancer screening work? A quasi-experimental study to evaluate the impact on attendance, attendance inequality and average cost per uptake of a Japanese government intervention. Int J Cancer 2013 Aug 15;133(4):972-983. DOI:10.1002/ijc.28095; PMID:23400833.

In conclusion, removing out-of-pocket costs improves female cancer screening uptake in Japan but may not be cost-saving. Although cost removal reduces inequalities in attendance for mammography, it appears to increase inequalities in Pap smear attendance.

Broberg G, Jonasson JM, Ellis J, Gyrd-Hansen D, Anjemark B, Glantz A, et al. Increasing participation in cervical cancer screening: telephone contact with long-term non-attendees in Sweden. Results from RACOMIP, a randomized controlled trial. Int J Cancer 2013 Jul;133(1):164-171. DOI:10.1002/ijc.27985; PMID:23233356.

Telephone contact with women who have abstained from cervical cancer screening for long time increases participation and leads to a significant increase in detection of atypical smears. Cost calculations indicate that this intervention is unlikely to be cost-generating and this strategy is feasible in the context of a screening program.
 
Barken SS, Lynge E, Andersen ES, Rebolj M. Long-term adherence to follow-up after treatment of cervical intraepithelial neoplasia: nationwide population-based study. Acta Obstet Gynecol Scand 2013 Jul;92(7):852-857. DOI:10.1111/aogs.12116; PMID:23418941.

CONCLUSIONS: Adherence to follow-up after conization was poor in Denmark. Our findings suggest that because of this poor adherence, recommendations for long-term annual follow-up after treatment of cervical intraepithelial neoplasia may not be highly effective. Shorter follow-up schedules using highly sensitive tests appear attractive.

Ostensson E, Hellstrom AC, Hellman K, Gustavsson I, Gyllensten U, Wilander E, et al. Projected cost-effectiveness of repeat high-risk human papillomavirus testing using self-collected vaginal samples in the Swedish cervical cancer screening program. Acta Obstet Gynecol Scand 2013 Jul;92(7):830-840. DOI:10.1111/aogs.12143; PMID:23530870.

BACKGROUND: Human papillomavirus (HPV) testing is not currently used in primary cervical cancer screening in Sweden, and corresponding cost-effectiveness is unclear. OBJECTIVE: From a societal perspective, to evaluate the cost-effectiveness of high-risk (HR)-HPV testing using self-collected vaginal samples. DESIGN: A cost-effectiveness analysis. SETTING: The Swedish organized cervical cancer screening program. METHODS: We constructed a model to simulate the natural history of cervical cancer using Swedish data on cervical cancer risk. For the base-case analysis we evaluated two screening strategies with different screening intervals: (i) cytology screening throughout the woman's lifetime (i.e. "conventional cytology strategy") and (ii) conventional cytology screening until age 35 years, followed by HR-HPV testing using self-collected vaginal samples in women aged >/=35 years (i.e. "combination strategy"). Sensitivity analyses were performed, varying model parameters over a significant range of values to identify cost-effective screening strategies. MAIN OUTCOME MEASURES: Average lifetime cost, discounted and undiscounted life-years gained, reduction in cervical cancer risk, incremental cost-effectiveness ratios with and without the cost of added life-years. RESULTS: Depending on screening interval, the incremental cost-effectiveness ratios for the combination strategy ranged from euro43,000 to euro180,000 per life-years gained without the cost of added life-years, and from euro74,000 to euro206,000 with costs of added life-years included. CONCLUSION: The combination strategy with a 5-year screening interval is potentially cost-effective compared with no screening, and with current screening practice when using a threshold value of euro80,000 per life-years gained.
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