{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:30:15Z","timestamp":1791271815898,"version":"4.1.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n To accelerate cervical cancer elimination, it is essential to evaluate the combined impact of ongoing screening and human papillomavirus (HPV) vaccination efforts, as the disease remains a significant global public health concern.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate how different cervical cancer screening strategies, along with HPV vaccination, affect the cervical cancer burden in South Korea.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This decision analytical model used a deterministic age-structured dynamic model to simulate HPV transmission and cervical cancer progression, considering sexual behavior and population structure, for the Korean population from 2024 to 2100. The study was conducted from April 2023 to September 2024.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Cervical cancer screening using Papanicolaou (Pap) or HPV testing, with HPV vaccination.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The cumulative number of incident cases of cervical cancer and deaths for the projected period are reported.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The study modeled more than 51 million Korean residents, with 25.88 million women (50.1%) and 10.05 million women aged 18 to 49 years. Among Pap test\u2013based strategies, biennial screening for women aged 20 years and older was associated with the lowest number of cervical cancer cases (47\u202f358) and deaths (34\u202f242) by 2100, with as much as a 10% mortality reduction compared with other Pap test\u2013based strategies. High-risk HPV (hrHPV) testing every 2 or 3 years was estimated to further reduce cases by as much as 27% and deaths by 13%. Depending on the screening strategy, cervical cancer elimination based on the World Health Organization definition (4 cases per 100\u202f000 women) could occur as early as 2038 (with 2-year hrHPV testing starting at age 25 years or older) or as late as 2055 (5-year Pap testing for individuals aged 25 to 64 years). The current screening policy (Pap test every 2 years starting at age 20 years) was estimated to reach disease elimination by 2044. In an ideal scenario with 70% screening and 90% vaccination coverage from 2030, an additional 12% of cases and 7% of deaths could be prevented. Strategies using a 2-year interval for hrHPV testing could lead to the earliest cervical cancer elimination by 2034.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this decision analytical model, an ideal scenario with higher cervical cancer screening and HPV vaccination rates was associated with substantially reduced cervical cancer incidence and mortality and accelerated elimination in South Korea. Notably, hrHPV testing with 2- or 3-year screening intervals was estimated to achieve elimination as early as 2034.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.26683","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T15:17:00Z","timestamp":1755011820000},"page":"e2526683","source":"Crossref","is-referenced-by-count":18,"title":["Cervical Cancer Screening, HPV Vaccination, and Cervical Cancer Elimination"],"prefix":"10.1001","volume":"8","author":[{"given":"Xuan Quy","family":"Luu","sequence":"first","affiliation":[{"name":"Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea"},{"name":"Department of Biostatistics, Faculty of Fundamental Science, Hanoi University of Public Health, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Kwan","family":"Jun","sequence":"additional","affiliation":[{"name":"Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea"},{"name":"National Cancer Control Institute, National Cancer Center, Goyang, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Suh","sequence":"additional","affiliation":[{"name":"Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea"},{"name":"National Cancer Control Institute, National Cancer Center, Goyang, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Kyoung","family":"Oh","sequence":"additional","affiliation":[{"name":"Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su-Yeon","family":"Yu","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Kangwon National University, Chuncheon, South Korea"},{"name":"Department of Medical Information College of Nursing and Health, Kongju National University, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kui Son","family":"Choi","sequence":"additional","affiliation":[{"name":"Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea"},{"name":"National Cancer Control Institute, National Cancer Center, Goyang, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"issue":"3","key":"zoi250752r1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"zoi250752r2","doi-asserted-by":"publisher","first-page":"e197","DOI":"10.1016\/S2214-109X(22)00501-0","article-title":"Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative.","volume":"11","author":"Singh","year":"2023","journal-title":"Lancet Glob Health"},{"issue":"4","key":"zoi250752r3","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1136\/ijgc-2020-001285","article-title":"World Health Organization call for action to eliminate cervical cancer globally.","volume":"30","author":"Gultekin","year":"2020","journal-title":"Int J Gynecol Cancer"},{"issue":"2","key":"zoi250752r5","doi-asserted-by":"publisher","first-page":"330","DOI":"10.4143\/crt.2022.128","article-title":"Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2019.","volume":"54","author":"Kang","year":"2022","journal-title":"Cancer Res Treat"},{"issue":"4","key":"zoi250752r6","doi-asserted-by":"publisher","DOI":"10.3802\/jgo.2022.33.e39","article-title":"Trends in cervical cancer screening rates among Korean women: results of the Korean National Cancer Screening Survey, 2005-2020.","volume":"33","author":"Shin","year":"2022","journal-title":"J Gynecol Oncol"},{"issue":"52","key":"zoi250752r7","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2018.33.e331","article-title":"Current status of human papillomavirus infection and introduction of vaccination to the national immunization program in Korea: an overview.","volume":"33","author":"Kim","year":"2018","journal-title":"J Korean Med Sci"},{"issue":"1","key":"zoi250752r10","doi-asserted-by":"publisher","DOI":"10.1080\/17513758.2024.2436376","article-title":"Computational approaches of modelling human papillomavirus transmission and prevention strategies: a systematic review.","volume":"19","author":"Wang","year":"2025","journal-title":"J Biol Dyn"},{"issue":"6","key":"zoi250752r11","first-page":"225","article-title":"Advances in HPV-associated cervical cancer dynamic modelling for prevention and control evaluation.","volume":"7","author":"He","year":"2025","journal-title":"China CDC Wkly"},{"issue":"1","key":"zoi250752r14","doi-asserted-by":"publisher","DOI":"10.3802\/jgo.2018.29.e14","article-title":"Prevalence of human papillomavirus genotypes and precancerous cervical lesions in a screening population in the Republic of Korea, 2014-2016.","volume":"29","author":"Ouh","year":"2018","journal-title":"J Gynecol Oncol"},{"issue":"6","key":"zoi250752r16","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1002\/ijc.11334","article-title":"A comprehensive natural history model of HPV infection and cervical cancer to estimate the clinical impact of a prophylactic HPV-16\/18 vaccine.","volume":"106","author":"Goldie","year":"2003","journal-title":"Int J Cancer"},{"issue":"11","key":"zoi250752r17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0079260","article-title":"Natural history of progression of HPV infection to cervical lesion or clearance: analysis of the control arm of the large, randomised PATRICIA study.","volume":"8","author":"Jaisamrarn","year":"2013","journal-title":"PLoS One"},{"issue":"5","key":"zoi250752r18","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1016\/S1470-2045(08)70103-7","article-title":"Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study.","volume":"9","author":"McCredie","year":"2008","journal-title":"Lancet Oncol"},{"issue":"18","key":"zoi250752r19","doi-asserted-by":"publisher","first-page":"5107","DOI":"10.1073\/pnas.1515528113","article-title":"National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States.","volume":"113","author":"Durham","year":"2016","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"1","key":"zoi250752r20","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12916-021-02204-0","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations.","volume":"20","author":"Husereau","year":"2022","journal-title":"BMC Med"},{"key":"zoi250752r21","doi-asserted-by":"publisher","DOI":"10.1016\/j.pvr.2019.100184","article-title":"HPV-FRAME: a consensus statement and quality framework for modelled evaluations of HPV-related cancer control.","volume":"8","author":"Canfell","year":"2019","journal-title":"Papillomavirus Res"},{"issue":"4","key":"zoi250752r24","doi-asserted-by":"publisher","first-page":"e213","DOI":"10.1016\/S2468-2667(20)30006-2","article-title":"Projected time to elimination of cervical cancer in the USA: a comparative modelling study.","volume":"5","author":"Burger","year":"2020","journal-title":"Lancet Public Health"},{"issue":"10224","key":"zoi250752r25","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/S0140-6736(20)30068-4","article-title":"Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries.","volume":"395","author":"Brisson","year":"2020","journal-title":"Lancet"},{"issue":"2","key":"zoi250752r26","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1002\/ijgo.16125","article-title":"Cost-effectiveness analysis of 9-valent human papillomavirus vaccine combined with screening for cervical cancer in Japan.","volume":"169","author":"Takamoto","year":"2025","journal-title":"Int J Gynaecol Obstet"},{"issue":"10108","key":"zoi250752r27","doi-asserted-by":"publisher","first-page":"2143","DOI":"10.1016\/S0140-6736(17)31821-4","article-title":"Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial.","volume":"390","author":"Huh","year":"2017","journal-title":"Lancet"},{"issue":"3","key":"zoi250752r28","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/S1470-2045(18)30836-2","article-title":"Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020-99: a modelling study.","volume":"20","author":"Simms","year":"2019","journal-title":"Lancet Oncol"},{"issue":"1","key":"zoi250752r29","doi-asserted-by":"publisher","first-page":"e19","DOI":"10.1016\/S2468-2667(18)30183-X","article-title":"The projected timeframe until cervical cancer elimination in Australia: a modelling study.","volume":"4","author":"Hall","year":"2019","journal-title":"Lancet Public Health"},{"issue":"12","key":"zoi250752r30","doi-asserted-by":"publisher","first-page":"1997","DOI":"10.1002\/ijc.33759","article-title":"The road to cervical cancer elimination in Malaysia: evaluation of the impact and cost-effectiveness of human papillomavirus screening with self-collection and digital registry support.","volume":"149","author":"Keane","year":"2021","journal-title":"Int J Cancer"},{"key":"zoi250752r8","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-540-78911-6","volume-title":"Mathematical Epidemiology","author":"Brauer","year":"2008"},{"key":"zoi250752r9","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780198545996.001.0001","volume-title":"Infectious Diseases of Humans: Dynamics and Control","author":"Anderson","year":"1991"},{"key":"zoi250752r4","unstructured":"World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. November 17, 2020. Accessed July 9, 2025. https:\/\/www.who.int\/publications\/i\/item\/9789240014107"},{"key":"zoi250752r12","unstructured":"Young? JL Jr, Roffers SD, Ries LAG, Fritz AG, Hurlbut AA, eds. SEER summary staging manual 2000: codes and coding instructions. Updated December 2012. Accessed July 9, 2025. https:\/\/seer.cancer.gov\/tools\/ssm\/ssm2000\/"},{"key":"zoi250752r13","unstructured":"Korea Disease Control and Prevention Agency. Accessed July 15, 2025. https:\/\/www.kdca.go.kr\/"},{"key":"zoi250752r15","unstructured":"Korean Statistical Information Service. Cancer incident cases and incidence rates by site (24 items), sex, age group. Accessed May 18, 2023. https:\/\/kosis.kr\/statHtml\/statHtml.do?orgId=117&tblId=DT_117N_A00023&language=en&conn_path=I3"},{"key":"zoi250752r22","unstructured":"Korean Statistical Information Service. Resident population in five-year age groups. Accessed May 18, 2023. https:\/\/kosis.kr\/statHtml\/statHtml.do?orgId=101&tblId=DT_1B04005N&conn_path=I2&language=en"},{"key":"zoi250752r23","unstructured":"Korean Statistical Information Service. Estimated population by scenario\/nationwide. Accessed May 18, 2023. https:\/\/kosis.kr\/statHtml\/statHtml.do?orgId=101&tblId=DT_1BPA401&conn_path=I3"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2837443\/luu_2025_oi_250752_1754068435.98799.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T15:17:03Z","timestamp":1755011823000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2837443"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,12]]},"references-count":30,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.26683","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,12]]}}}