{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T22:50:39Z","timestamp":1789253439188,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,1,13]],"date-time":"2020-01-13T00:00:00Z","timestamp":1578873600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004955","name":"\u00d6sterreichische Forschungsf\u00f6rderungsgesellschaft","doi-asserted-by":"publisher","award":["849220"],"award-info":[{"award-number":["849220"]}],"id":[{"id":"10.13039\/501100004955","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2020,8,15]]},"abstract":"<jats:p>A general concern exists that cervical cancer screening using human papillomavirus (HPV) testing may lead to considerable overtreatment. We evaluated the trade\u2010off between benefits and overtreatment among different screening strategies differing by primary tests (cytology, p16\/Ki\u201067, HPV alone or in combinations), interval, age and diagnostic follow\u2010up algorithms. A Markov state\u2010transition model calibrated to the Austrian epidemiological context was used to predict cervical cancer cases, deaths, overtreatments and incremental harm\u2013benefit ratios (IHBR) for each strategy. When considering the same screening interval, HPV\u2010based screening strategies were more effective compared to cytology or p16\/Ki\u201067 testing (e.g., relative reduction in cervical cancer with biennial screening: 67.7% for HPV\u2009+\u2009Pap cotesting, 57.3% for cytology and 65.5% for p16\/Ki\u201067), but were associated with increased overtreatment (e.g., 19.8% more conizations with biennial HPV\u2009+\u2009Papcotesting vs. biennial cytology). The IHBRs measured in unnecessary conizations per additional prevented cancer\u2010related death were 31 (quinquennial Pap\u2009+\u2009p16\/Ki\u201067\u2010triage), 49 (triennial Pap\u2009+\u2009p16\/Ki\u201067\u2010triage), 58 (triennial HPV\u2009+\u2009Pap cotesting), 66 (biennial HPV\u2009+\u2009Pap cotesting), 189 (annual Pap\u2009+\u2009p16\/Ki\u201067\u2010triage) and 401 (annual p16\/Ki\u201067 testing alone). The IHBRs increased significantly with increasing screening adherence rates and slightly with lower age at screening initiation, with a reduction in HPV incidence or with lower Pap\u2010test sensitivity. Depending on the accepted IHBR threshold, biennial or triennial HPV\u2010based screening in women as of age 30 and biennial cytology in younger women may be considered in opportunistic screening settings with low or moderate adherence such as in Austria. In organized settings with high screening adherence and in postvaccination settings with lower HPV prevalence, the interval may be prolonged.<\/jats:p>","DOI":"10.1002\/ijc.32849","type":"journal-article","created":{"date-parts":[[2019,12,24]],"date-time":"2019-12-24T03:16:14Z","timestamp":1577157374000},"page":"1131-1142","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Reducing overtreatment associated with overdiagnosis in cervical cancer screening\u2014A model\u2010based benefit\u2013harm analysis for Austria"],"prefix":"10.1002","volume":"147","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5193-0492","authenticated-orcid":false,"given":"Gaby","family":"Sroczynski","sequence":"first","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment UMIT \u2010 University for Health Sciences, Medical Informatics and Technology  Hall i.T. Austria"},{"name":"Division of Health Technology Assessment and Bioinformatics ONCOTYROL \u2010 Center for Personalized Cancer Medicine  Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Esteban","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment UMIT \u2010 University for Health Sciences, Medical Informatics and Technology  Hall i.T. Austria"},{"name":"Division of Health Technology Assessment and Bioinformatics ONCOTYROL \u2010 Center for Personalized Cancer Medicine  Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Widschwendter","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Medical University Innsbruck  Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilhelm","family":"Oberaigner","sequence":"additional","affiliation":[{"name":"Institute for Clinical Epidemiology Cancer Registry Tyrol, Tirol Kliniken  Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8011-5825","authenticated-orcid":false,"given":"Wegene","family":"Borena","sequence":"additional","affiliation":[{"name":"Division of Virology, Department of Hygiene, Microbiology, Social Medicine Medical University of Innsbruck  Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5825-7237","authenticated-orcid":false,"given":"Dorothee","family":"von Laer","sequence":"additional","affiliation":[{"name":"Division of Virology, Department of Hygiene, Microbiology, Social Medicine Medical University of Innsbruck  Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Hackl","sequence":"additional","affiliation":[{"name":"Statistics Austria Austrian National Cancer Registry  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gottfried","family":"Endel","sequence":"additional","affiliation":[{"name":"Department for Evidence\u2010Based Economic Health Care Main Association of Austrian Social Insurance Institutions  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6425-7671","authenticated-orcid":false,"given":"Uwe","family":"Siebert","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment UMIT \u2010 University for Health Sciences, Medical Informatics and Technology  Hall i.T. Austria"},{"name":"Division of Health Technology Assessment and Bioinformatics ONCOTYROL \u2010 Center for Personalized Cancer Medicine  Innsbruck Austria"},{"name":"Center for Health Decision Science, Department of Health Policy and Management Harvard T.H. Chan School of Public Health  Boston MA"},{"name":"Institute for Technology Assessment and Department of Radiology Massachusetts General Hospital, Harvard Medical School  Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,13]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdp471"},{"key":"e_1_2_9_4_1","volume-title":"Human papillomavirus and related diseases in Austria. Summary report 2015 03\u201320","author":"Bruni L","year":"2015"},{"key":"e_1_2_9_5_1","unstructured":"Statistik Austria. Geb\u00e4rmutterhals (C53). 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