{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T21:16:40Z","timestamp":1793999800658,"version":"4.8.0"},"reference-count":84,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:00Z","timestamp":1702339200000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Nat Med"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    In 2020, the World Health Organization (WHO) launched a strategy to eliminate cervical cancer as a public health problem. To support the strategy, the WHO published updated cervical screening guidelines in 2021. To inform this update, we used an established modeling platform,\n                    <jats:italic>Policy1-Cervix<\/jats:italic>\n                    , to evaluate the impact of seven primary screening scenarios across 78 low- and lower-middle-income countries (LMICs) for the general population of women. Assuming 70% coverage, we found that primary human papillomavirus (HPV) screening approaches were the most effective and cost-effective, reducing cervical cancer age-standardized mortality rates by 63\u201367% when offered every 5\u2009years. Strategies involving triaging women before treatment (with 16\/18 genotyping, cytology, visual inspection with acetic acid (VIA) or colposcopy) had close-to-similar effectiveness to HPV screening without triage and fewer pre-cancer treatments. Screening with VIA or cytology every 3\u2009years was less effective and less cost-effective than HPV screening every 5\u2009years. Furthermore, VIA generated more than double the number of pre-cancer treatments compared to HPV. In conclusion, primary HPV screening is the most effective, cost-effective and efficient cervical screening option in LMICs. These findings have directly informed WHO\u2019s updated cervical screening guidelines for the general population of women, which recommend primary HPV screening in a screen-and-treat or screen-triage-and-treat approach, starting from age 30\u2009years with screening every 5\u2009years or 10\u2009years.\n                  <\/jats:p>","DOI":"10.1038\/s41591-023-02600-4","type":"journal-article","created":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T06:03:12Z","timestamp":1702360992000},"page":"3050-3058","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":106,"title":["Benefits, harms and cost-effectiveness of cervical screening, triage and treatment strategies for women in the general population"],"prefix":"10.1038","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2568-7956","authenticated-orcid":false,"given":"Kate T.","family":"Simms","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Keane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diep Thi Ngoc","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5439-6552","authenticated-orcid":false,"given":"Michael","family":"Caruana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8989-1449","authenticated-orcid":false,"given":"Michaela T.","family":"Hall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gigi","family":"Lui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Gauvreau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Owen","family":"Demke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Arbyn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Partha","family":"Basu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1251-0836","authenticated-orcid":false,"given":"Nicolas","family":"Wentzensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Lauby-Secretan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Ilbawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Hutubessy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maribel","family":"Almonte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"De Sanjos\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Kelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shona","family":"Dalal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda O.","family":"Eckert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Santesso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Broutet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Canfell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,12,12]]},"reference":[{"key":"2600_CR1","unstructured":"Ferlay, J et al. Global Cancer Observatory: Cancer Today. International Agency for Research on Cancer (Lyon, France). https:\/\/gco.iarc.fr\/today (2020)."},{"key":"2600_CR2","unstructured":"World Health Organization. WHO Director-General calls for all countries to take action to help end the suffering caused by cervical cancer. https:\/\/www.who.int\/reproductivehealth\/call-to-action-elimination-cervical-cancer\/en\/ (2019)."},{"key":"2600_CR3","unstructured":"World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. https:\/\/www.who.int\/publications\/i\/item\/9789240014107 (2020)."},{"key":"2600_CR4","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/S0140-6736(20)30068-4","volume":"395","author":"M Brisson","year":"2020","unstructured":"Brisson, M. et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet 395, 575\u2013590 (2020).","journal-title":"Lancet"},{"key":"2600_CR5","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/S0140-6736(20)30157-4","volume":"395","author":"K Canfell","year":"2020","unstructured":"Canfell, K. et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet 395, 591\u2013603 (2020).","journal-title":"Lancet"},{"key":"2600_CR6","unstructured":"World Health Organization. WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/94830\/9789241548694_eng.pdf?sequence=1 (2013)."},{"key":"2600_CR7","doi-asserted-by":"crossref","first-page":"e96","DOI":"10.1016\/S2468-2667(17)30007-5","volume":"2","author":"J-B Lew","year":"2017","unstructured":"Lew, J.-B. et al. Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program. Lancet Public Health 2, e96\u2013e107 (2017).","journal-title":"Lancet Public Health"},{"key":"2600_CR8","doi-asserted-by":"crossref","first-page":"e0151619","DOI":"10.1371\/journal.pone.0151619","volume":"11","author":"J-B Lew","year":"2016","unstructured":"Lew, J.-B. et al. Effectiveness modelling and economic evaluation of primary HPV screening for cervical cancer prevention in New Zealand. PLoS ONE 11, e0151619 (2016).","journal-title":"PLoS ONE"},{"key":"2600_CR9","doi-asserted-by":"crossref","first-page":"dju009","DOI":"10.1093\/jnci\/dju009","volume":"106","author":"SS Shastri","year":"2014","unstructured":"Shastri, S. S. et al. Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India. J. Natl Cancer Inst. 106, dju009 (2014).","journal-title":"J. Natl Cancer Inst."},{"key":"2600_CR10","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1056\/NEJMoa0808516","volume":"360","author":"R Sankaranarayanan","year":"2009","unstructured":"Sankaranarayanan, R. et al. HPV screening for cervical cancer in rural India. N. Engl. J. Med. 360, 1385\u20131394 (2009).","journal-title":"N. Engl. J. Med."},{"key":"2600_CR11","doi-asserted-by":"crossref","first-page":"101645","DOI":"10.1016\/j.eclinm.2022.101645","volume":"53","author":"H Kelly","year":"2022","unstructured":"Kelly, H. et al. Diagnostic accuracy of cervical cancer screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+\/CIN3+) among women living with HIV: a systematic review and meta-analysis. eClinicalMedicine 53, 101645 (2022).","journal-title":"eClinicalMedicine"},{"key":"2600_CR12","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1056\/NEJMsr2030640","volume":"385","author":"V Bouvard","year":"2021","unstructured":"Bouvard, V. et al. The IARC perspective on cervical cancer screening. N. Engl. J. Med. 385, 1908\u20131918 (2021).","journal-title":"N. Engl. J. Med."},{"key":"2600_CR13","unstructured":"World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. https:\/\/apps.who.int\/iris\/rest\/bitstreams\/1354685\/retrieve (2021)."},{"key":"2600_CR14","doi-asserted-by":"publisher","unstructured":"Hall, M. et al. Evaluation of the benefits and harms of alternative strategies for cervical screening and treatment in women living with HIV: modelling to support WHO 2021 cervical screening and treatment guidelines to prevent cervical cancer. Preprint at Research Square https:\/\/doi.org\/10.21203\/rs.3.rs-2403727\/v1 (2023).","DOI":"10.21203\/rs.3.rs-2403727\/v1"},{"key":"2600_CR15","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.1016\/S2468-2667(18)30183-X","volume":"4","author":"MT Hall","year":"2019","unstructured":"Hall, M. T. et al. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health 4, e19\u2013e27 (2019).","journal-title":"Lancet Public Health"},{"key":"2600_CR16","doi-asserted-by":"crossref","first-page":"e66","DOI":"10.1016\/S2468-2667(16)30019-6","volume":"1","author":"KT Simms","year":"2016","unstructured":"Simms, K. T. et al. Cost-effectiveness of the next generation nonavalent human papillomavirus vaccine in the context of primary human papillomavirus screening in Australia: a comparative modelling analysis. Lancet Public Health 1, e66\u2013e75 (2016).","journal-title":"Lancet Public Health"},{"key":"2600_CR17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta18230","volume":"18","author":"HC Kitchener","year":"2014","unstructured":"Kitchener, H. C. et al. The clinical effectiveness and cost-effectiveness of primary human papillomavirus cervical screening in England: extended follow-up of the ARTISTIC randomised trial cohort through three screening rounds. Health Technol. Assess. 18, 1\u2013196 (2014).","journal-title":"Health Technol. Assess."},{"key":"2600_CR18","doi-asserted-by":"crossref","first-page":"2771","DOI":"10.1002\/ijc.30392","volume":"139","author":"KT Simms","year":"2016","unstructured":"Simms, K. T. et al. Will cervical screening remain cost-effective in women offered the next generation nonavalent HPV vaccine? Results for four developed countries. Int. J. Cancer 139, 2771\u20132780 (2016).","journal-title":"Int. J. Cancer"},{"key":"2600_CR19","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1158\/1055-9965.EPI-20-0998","volume":"30","author":"MA Smith","year":"2021","unstructured":"Smith, M. A. et al. Could HPV testing on self-collected samples be routinely used in an organised cervical screening program? A modelled analysis. Cancer Epidemiol. Biomarkers Prev. 30, 268\u2013277 (2021).","journal-title":"Cancer Epidemiol. Biomarkers Prev."},{"key":"2600_CR20","doi-asserted-by":"crossref","first-page":"e223","DOI":"10.1016\/S2468-2667(20)30010-4","volume":"5","author":"KT Simms","year":"2020","unstructured":"Simms, K. T., Hanley, S. J. B., Smith, M. A., Keane, A. & Canfell, K. Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study. Lancet Public Health 5, e223\u2013e234 (2020).","journal-title":"Lancet Public Health"},{"key":"2600_CR21","doi-asserted-by":"crossref","unstructured":"Burger, E. A. et al. Projected time to elimination of cervical cancer in the USA: a comparative modelling study. Lancet Public Health. 5, e213\u2013e222 (2020).","DOI":"10.1016\/S2468-2667(20)30006-2"},{"key":"2600_CR22","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/S1470-2045(18)30836-2","volume":"20","author":"KT Simms","year":"2019","unstructured":"Simms, K. T. et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020\u201399: a modelling study. Lancet Oncol. 20, 394\u2013407 (2019).","journal-title":"Lancet Oncol."},{"key":"2600_CR23","doi-asserted-by":"crossref","first-page":"e0231388","DOI":"10.1371\/journal.pone.0231388","volume":"15","author":"MT Hall","year":"2020","unstructured":"Hall, M. T. et al. The past, present and future impact of HIV prevention and control on HPV and cervical disease in Tanzania: a modelling study. PLoS ONE 15, e0231388 (2020).","journal-title":"PLoS ONE"},{"key":"2600_CR24","unstructured":"Feachem, R. G. A. Commission on Macroeconomics and Health. Bull. World Health Organ. 80, 87 (2002)."},{"key":"2600_CR25","doi-asserted-by":"crossref","first-page":"2416","DOI":"10.1002\/ijc.33029","volume":"147","author":"Z Xue","year":"2020","unstructured":"Xue, Z. et al. A demonstration of automated visual evaluation of cervical images taken with a smartphone camera. Int. J. Cancer 147, 2416\u20132423 (2020).","journal-title":"Int. J. Cancer"},{"key":"2600_CR26","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1002\/ijc.33759","volume":"149","author":"A Keane","year":"2021","unstructured":"Keane, A. et al. The road to cervical cancer elimination in Malaysia: evaluation of the impact and cost\u2010effectiveness of human papillomavirus screening with self\u2010collection and digital registry support. Int. J. Cancer 149, 1997\u20132009 (2021).","journal-title":"Int. J. Cancer"},{"key":"2600_CR27","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/S1470-2045(22)00294-7","volume":"23","author":"M Arbyn","year":"2022","unstructured":"Arbyn, M. et al. Accuracy and effectiveness of HPV mRNA testing in cervical cancer screening: a systematic review and meta-analysis. Lancet Oncol. 23, 950\u2013960 (2022).","journal-title":"Lancet Oncol."},{"key":"2600_CR28","unstructured":"World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention: use of mRNA tests for human papillomavirus (HPV). https:\/\/www.who.int\/publications\/i\/item\/9789240040434 (2021)."},{"key":"2600_CR29","unstructured":"UNAIDS. Country progress report\u2014United Republic of Tanzania. Global AIDS Monitoring 2020. https:\/\/www.unaids.org\/sites\/default\/files\/country\/documents\/TZA_2020_countryreport.pdf (2020)."},{"key":"2600_CR30","doi-asserted-by":"crossref","unstructured":"Kyrgiou, M. et al. Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease. Cochrane Database Syst. Rev. 11, CD012847 (2017).","DOI":"10.1002\/14651858.CD012847"},{"key":"2600_CR31","unstructured":"World Health Organization. Immunization dashboard. https:\/\/immunizationdata.who.int\/"},{"key":"2600_CR32","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.cmi.2021.04.031","volume":"27","author":"M Arbyn","year":"2021","unstructured":"Arbyn, M. et al. 2020 list of human papillomavirus assays suitable for primary cervical cancer screening. Clin. Microbiol Infect. 27, 1083\u20131095 (2021).","journal-title":"Clin. Microbiol Infect."},{"key":"2600_CR33","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-6810-5","volume":"19","author":"MB Fitzpatrick","year":"2019","unstructured":"Fitzpatrick, M. B. et al. Community-based self-collected human papillomavirus screening in rural Zimbabwe. BMC Public Health 19, 603 (2019).","journal-title":"BMC Public Health"},{"key":"2600_CR34","doi-asserted-by":"crossref","first-page":"k4823","DOI":"10.1136\/bmj.k4823","volume":"363","author":"M Arbyn","year":"2018","unstructured":"Arbyn, M., Smith, S. B., Temin, S., Sultana, F. & Castle, P. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses. BMJ 363, k4823 (2018).","journal-title":"BMJ"},{"key":"2600_CR35","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1136\/sextrans-2016-052609","volume":"93","author":"EJ Nelson","year":"2017","unstructured":"Nelson, E. J. et al. The acceptability of self-sampled screening for HPV DNA: a systematic review and meta-analysis. Sex. Transm. Infect. 93, 56\u201361 (2017).","journal-title":"Sex. Transm. Infect."},{"key":"2600_CR36","doi-asserted-by":"crossref","first-page":"e1336","DOI":"10.1016\/S2214-109X(22)00271-6","volume":"10","author":"AJ Vallely","year":"2022","unstructured":"Vallely, A. J. et al. Point-of-care HPV DNA testing of self-collected specimens and same-day thermal ablation for the early detection and treatment of cervical pre-cancer in women in Papua New Guinea: a prospective, single-arm intervention trial (HPV-STAT). Lancet Glob. Health 10, e1336\u2013e1346 (2022).","journal-title":"Lancet Glob. Health"},{"key":"2600_CR37","doi-asserted-by":"crossref","first-page":"e007380","DOI":"10.1136\/bmjgh-2021-007380","volume":"7","author":"DTN Nguyen","year":"2022","unstructured":"Nguyen, D. T. N. et al. Towards the elimination of cervical cancer in low-income and lower-middle-income countries: modelled evaluation of the effectiveness and cost-effectiveness of point-of-care HPV self-collected screening and treatment in Papua New Guinea. BMJ Glob. Health 7, e007380 (2022).","journal-title":"BMJ Glob. Health"},{"key":"2600_CR38","unstructured":"Minderoo Foundation. Collaborative cervical cancer program established in the Western Pacific through landmark investment. https:\/\/www.minderoo.org\/collaborate-against-cancer\/news\/collaborative-cervical-cancer-program-established-in-the-western-pacific-through-landmark-investment\/ (2023)."},{"key":"2600_CR39","unstructured":"World Health Organization. WHO guidelines for the use of thermal ablation for cervical pre-cancer lesions. https:\/\/www.who.int\/publications\/i\/item\/9789241550598 (2019)."},{"key":"2600_CR40","unstructured":"World Health Organization. \u2018Best Buys\u2019 and other recommended interventions for the prevention and control of noncommunicable diseases. https:\/\/www.who.int\/ncds\/management\/WHO_Appendix_BestBuys.pdf (2017)."},{"key":"2600_CR41","doi-asserted-by":"crossref","first-page":"e66","DOI":"10.1016\/S2468-2667(16)30019-6","volume":"1","author":"KT Simms","year":"2017","unstructured":"Simms, K. T. et al. Cost-effectiveness of the next generation nonavalent human papillomavirus vaccine in the context of primary human papillomavirus screening in Australia: a comparative modelling analysis. Lancet Public Health 1, e66\u2013e75 (2017).","journal-title":"Lancet Public Health"},{"key":"2600_CR42","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/s12913-016-1375-9","volume":"16","author":"MA Smith","year":"2016","unstructured":"Smith, M. A. et al. Transitioning from cytology-based screening to HPV-based screening at longer intervals: implications for resource use. BMC Health Serv. Res. 16, 147 (2016).","journal-title":"BMC Health Serv. Res."},{"key":"2600_CR43","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.ygyno.2018.10.045","volume":"152","author":"MT Hall","year":"2019","unstructured":"Hall, M. T. et al. The combined impact of implementing HPV immunisation and primary HPV screening in New Zealand: transitional and long-term benefits, costs and resource utilisation implications. Gynecol. Oncol. 152, 472\u2013479 (2019).","journal-title":"Gynecol. Oncol."},{"key":"2600_CR44","doi-asserted-by":"crossref","first-page":"e0185332","DOI":"10.1371\/journal.pone.0185332","volume":"13","author":"MT Hall","year":"2018","unstructured":"Hall, M. T. et al. Projected future impact of HPV vaccination and primary HPV screening on cervical cancer rates from 2017\u20132035: example from Australia. PLoS ONE 13, e0185332 (2018).","journal-title":"PLoS ONE"},{"key":"2600_CR45","doi-asserted-by":"crossref","first-page":"e0163509","DOI":"10.1371\/journal.pone.0163509","volume":"12","author":"KT Simms","year":"2017","unstructured":"Simms, K. T. et al. Optimal management strategies for primary HPV testing for cervical screening: cost-effectiveness evaluation for the National Cervical Screening Program in Australia. PLoS ONE 12, e0163509 (2017).","journal-title":"PLoS ONE"},{"key":"2600_CR46","unstructured":"Medical Services Advisory Committee. Human Papillomavirus Triage Test For Women With Possible or Definite Low-Grade Squamous Intraepithelial Lesions: MSAC reference 39, Assessment report (Commonwealth of Australia, 2009)."},{"key":"2600_CR47","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1038\/sj.bjc.6602002","volume":"91","author":"K Canfell","year":"2004","unstructured":"Canfell, K., Barnabas, R., Patnick, J. & Beral, V. The predicted effect of changes in cervical screening practice in the UK: results from a modelling study. Br. J. Cancer 91, 530\u2013536 (2004).","journal-title":"Br. J. Cancer"},{"key":"2600_CR48","doi-asserted-by":"crossref","unstructured":"Canfell, K., Lew, J.B., Smith, M. & Walker, R. Cost-effectiveness modelling beyond MAVARIC study end-points. in MAVARIC\u2014a comparison of automation-assisted and manual cervical screening: a randomised controlled trial (eds Kitchener, H. C. et al.) Health Technology Assessment Vol. 15 No. 3 (2011).","DOI":"10.3310\/hta15030"},{"key":"2600_CR49","unstructured":"Medical Services Advisory Committee. Automation Assisted and Liquid Based Cytology for Cervical Cancer Screening: MSAC reference 1122, Assessment report (Commonwealth of Australia, 2009)."},{"key":"2600_CR50","doi-asserted-by":"crossref","first-page":"e7086","DOI":"10.1136\/bmj.e7086","volume":"345","author":"R Legood","year":"2012","unstructured":"Legood, R. et al. Cost effectiveness of human papillomavirus test of cure after treatment for cervical intraepithelial neoplasia in England: economic analysis from NHS Sentinel Sites Study. BMJ 345, e7086 (2012).","journal-title":"BMJ"},{"key":"2600_CR51","doi-asserted-by":"crossref","first-page":"2487","DOI":"10.1016\/j.vaccine.2010.12.085","volume":"29","author":"K Canfell","year":"2011","unstructured":"Canfell, K. et al. Prevention of cervical cancer in rural China: evaluation of HPV vaccination and primary HPV screening strategies. Vaccine 29, 2487\u20132494 (2011).","journal-title":"Vaccine"},{"key":"2600_CR52","volume":"11","author":"JF Shi","year":"2011","unstructured":"Shi, J. F. et al. Evaluation of primary HPV-DNA testing in relation to visual inspection methods for cervical cancer screening in rural China: an epidemiologic and cost-effectiveness modelling study. BMC Cancer 11, 239 (2011).","journal-title":"BMC Cancer"},{"key":"2600_CR53","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1002\/ijc.23633","volume":"123","author":"MA Smith","year":"2008","unstructured":"Smith, M. A., Canfell, K., Brotherton, J. M., Lew, J.-B. & Barnabas, R. V. The predicted impact of vaccination on human papillomavirus infections in Australia. Int. J. Cancer 123, 1854\u20131863 (2008).","journal-title":"Int. J. Cancer"},{"key":"2600_CR54","doi-asserted-by":"crossref","first-page":"9112","DOI":"10.1016\/j.vaccine.2011.02.091","volume":"29","author":"MA Smith","year":"2011","unstructured":"Smith, M. A. et al. The predicted impact of HPV vaccination on male infections and male HPV-related cancers in Australia. Vaccine 29, 9112\u20139122 (2011).","journal-title":"Vaccine"},{"key":"2600_CR55","volume":"7","author":"MA Smith","year":"2014","unstructured":"Smith, M. A. & Canfell, K. Testing previous model predictions against new data on human papillomavirus vaccination program outcomes. BMC Res. Notes 7, 109 (2014).","journal-title":"BMC Res. Notes"},{"key":"2600_CR56","unstructured":"Lew, J.-B. et al. National Cervical Screening Program Renewal: Effectiveness Modelling and Economic Evaluation in the Australian Setting (Assessment Report). MSAC application number 1276 (Commonwealth of Australia, 2014)."},{"key":"2600_CR57","doi-asserted-by":"crossref","first-page":"2410","DOI":"10.1002\/ijc.30926","volume":"141","author":"LS Velentzis","year":"2017","unstructured":"Velentzis, L. S. et al. How will transitioning from cytology to HPV testing change the balance between the benefits and harms of cervical cancer screening? Estimates of the impact on cervical cancer, treatment rates and adverse obstetric outcomes in Australia, a high vaccination coverage country. Int. J. Cancer 141, 2410\u20132422 (2017).","journal-title":"Int. J. Cancer"},{"key":"2600_CR58","doi-asserted-by":"crossref","first-page":"6314","DOI":"10.1016\/j.vaccine.2018.08.063","volume":"36","author":"MA Smith","year":"2018","unstructured":"Smith, M. A., Hall, M., Lew, J.-B. & Canfell, K. Potential for HPV vaccination and primary HPV screening to reduce cervical cancer disparities: example from New Zealand. Vaccine 36, 6314\u20136324 (2018).","journal-title":"Vaccine"},{"key":"2600_CR59","unstructured":"Cancer Council NSW. Policy1-Cervix Documentation. http:\/\/www.policy1.org\/models\/cervix\/documentation (2019)."},{"key":"2600_CR60","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1093\/jnci\/djz227","volume":"112","author":"EA Burger","year":"2020","unstructured":"Burger, E. A. et al. Estimating the natural history of cervical carcinogenesis using simulation models: a CISNET comparative analysis. J. Natl Cancer Inst. 112, 955\u2013963 (2020).","journal-title":"J. Natl Cancer Inst."},{"key":"2600_CR61","doi-asserted-by":"crossref","first-page":"100184","DOI":"10.1016\/j.pvr.2019.100184","volume":"8","author":"K Canfell","year":"2019","unstructured":"Canfell, K. et al. HPV-FRAME: a consensus statement and quality framework for modelled evaluations of HPV-related cancer control. Papillomavirus Res. 8, 100184 (2019).","journal-title":"Papillomavirus Res."},{"key":"2600_CR62","unstructured":"United Nations. Department of Economic and Social Affairs. Fertility. Age-Specific Fertility Rate. https:\/\/population.un.org\/wpp\/Download\/Standard\/Fertility\/"},{"key":"2600_CR63","first-page":"CD001318","volume":"2013","author":"PP Martin-Hirsch","year":"2013","unstructured":"Martin-Hirsch, P. P., Paraskevaidis, E., Bryant, A. & Dickinson, H. O. Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst. Rev. 2013, CD001318 (2013).","journal-title":"Cochrane Database Syst. Rev."},{"key":"2600_CR64","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1111\/j.1447-0756.2011.01832.x","volume":"38","author":"LL Sun","year":"2012","unstructured":"Sun, L. L. et al. Value-based medicine analysis on loop electrosurgical excision procedure and CO2 laser vaporization for the treatment of cervical intraepithelial neoplasia 2. J. Obstet. Gynaecol. Res. 38, 1064\u20131070 (2012).","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"2600_CR65","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s13224-011-0048-1","volume":"61","author":"A Singh","year":"2011","unstructured":"Singh, A., Arthur, B. & Agarwal, V. LEEP verses cryotherapy in CIN. J. Obstet. Gynaecol. India 61, 431\u2013435 (2011).","journal-title":"J. Obstet. Gynaecol. India"},{"key":"2600_CR66","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/S0140-6736(94)90881-8","volume":"343","author":"A Bigrigg","year":"1994","unstructured":"Bigrigg, A., Haffenden, D. K., Sheehan, A. L., Codling, B. W. & Read, M. D. Efficacy and safety of large-loop excision of the transformation zone. Lancet 343, 32\u201334 (1994).","journal-title":"Lancet"},{"key":"2600_CR67","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1177\/030089160208800609","volume":"88","author":"S Cecchini","year":"2002","unstructured":"Cecchini, S., Visioli, C. B., Zappa, M. & Ciatto, S. Recurrence after treatment by loop electrosurgical excision procedure (LEEP) of high-grade cervical intraepithelial neoplasia. Tumori 88, 478\u2013480 (2002).","journal-title":"Tumori"},{"key":"2600_CR68","first-page":"828","volume":"95","author":"E Paraskevaidis","year":"2000","unstructured":"Paraskevaidis, E. et al. Cervical intraepithelial neoplasia outcomes after large loop excision with clear margins. Obstet. Gynecol. 95, 828\u2013831 (2000).","journal-title":"Obstet. Gynecol."},{"key":"2600_CR69","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/j.1479-828X.1996.tb02725.x","volume":"36","author":"B Powell","year":"1996","unstructured":"Powell, B. The use of large loop excision of the transformation zone (LLETZ) in an outpatient setting. Aust. N. Z. J. Obstet. Gynaecol. 36, 338\u2013346 (1996).","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"2600_CR70","doi-asserted-by":"crossref","first-page":"217","DOI":"10.3802\/jgo.2012.23.4.217","volume":"23","author":"A Ryu","year":"2012","unstructured":"Ryu, A., Nam, K., Kwak, J., Kim, J. & Jeon, S. Early human papillomavirus testing predicts residual\/recurrent disease after LEEP. J. Gynecol. Oncol. 23, 217\u2013225 (2012).","journal-title":"J. Gynecol. Oncol."},{"key":"2600_CR71","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ejogrb.2007.10.017","volume":"139","author":"MA van der Aa","year":"2008","unstructured":"van der Aa, M. A., Schutter, E. M., Looijen-Salamon, M., Martens, J. E. & Siesling, S. Differences in screening history, tumour characteristics and survival between women with screen-detected versus not screen-detected cervical cancer in the east of The Netherlands, 1992\u20132001. Eur. J. Obstet. Gynecol. Reprod. Biol. 139, 204\u2013209 (2008).","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"2600_CR72","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.ypmed.2013.05.018","volume":"57","author":"A Zucchetto","year":"2013","unstructured":"Zucchetto, A. et al. Screening patterns within organized programs and survival of Italian women with invasive cervical cancer. Prev. Med. 57, 220\u2013226 (2013).","journal-title":"Prev. Med."},{"key":"2600_CR73","doi-asserted-by":"crossref","first-page":"e900","DOI":"10.1136\/bmj.e900","volume":"344","author":"B Andrae","year":"2012","unstructured":"Andrae, B. et al. Screening and cervical cancer cure: population based cohort study. BMJ 344, e900 (2012).","journal-title":"BMJ"},{"key":"2600_CR74","unstructured":"United Nations. World Population Prospects: The 2015 Revision. https:\/\/esa.un.org\/unpd\/wpp\/ (2015)."},{"key":"2600_CR75","doi-asserted-by":"crossref","first-page":"e1115","DOI":"10.1016\/S2214-109X(22)00241-8","volume":"10","author":"L Bruni","year":"2022","unstructured":"Bruni, L. et al. Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: a review and synthetic analysis. Lancet Glob. Health 10, e1115\u2013e1127 (2022).","journal-title":"Lancet Glob. Health"},{"key":"2600_CR76","unstructured":"World Health Organization. WHO guide for standardization of economic evaluations of immunization programmes. https:\/\/apps.who.int\/iris\/rest\/bitstreams\/1257211\/retrieve (2019)."},{"key":"2600_CR77","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.puhe.2018.07.006","volume":"163","author":"P Petrou","year":"2018","unstructured":"Petrou, P., Samoutis, G. & Lionis, C. Single-payer or a multipayer health system: a systematic literature review. Public Health 163, 141\u2013152 (2018).","journal-title":"Public Health"},{"key":"2600_CR78","unstructured":"World Health Organization. Updated Appendix 3 of the WHO Global NCD Action Plan 2013\u20132030. https:\/\/cdn.who.int\/media\/docs\/default-source\/ncds\/mnd\/2022_discussion_paper_final.pdf?sfvrsn=78343686_7 (2021)."},{"key":"2600_CR79","unstructured":"World Health Organization. WHO report on cancer: setting priorities, investing wisely and providing care for all. https:\/\/www.who.int\/publications\/i\/item\/9789240001299 (2020)."},{"key":"2600_CR80","unstructured":"World Bank. GDP per capita (current US$). https:\/\/data.worldbank.org\/indicator\/NY.GDP.MKTP.CD"},{"key":"2600_CR81","doi-asserted-by":"crossref","first-page":"925","DOI":"10.2471\/BLT.15.164418","volume":"94","author":"MY Bertram","year":"2016","unstructured":"Bertram, M. Y. et al. Cost-effectiveness thresholds: pros and cons. Bull. World Health Organ. 94, 925\u2013930 (2016).","journal-title":"Bull. World Health Organ."},{"key":"2600_CR82","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/s40273-014-0162-x","volume":"32","author":"AT Newall","year":"2014","unstructured":"Newall, A. T., Jit, M. & Hutubessy, R. Are current cost-effectiveness thresholds for low- and middle-income countries useful? Examples from the world of vaccines. Pharmacoeconomics 32, 525\u2013531 (2014).","journal-title":"Pharmacoeconomics"},{"key":"2600_CR83","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1016\/S0140-6736(12)61680-8","volume":"380","author":"JA Salomon","year":"2012","unstructured":"Salomon, J. A. et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet 380, 2129\u20132143 (2012).","journal-title":"Lancet"},{"key":"2600_CR84","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1002\/pon.2003","volume":"21","author":"M Drolet","year":"2012","unstructured":"Drolet, M. et al. The psychosocial impact of an abnormal cervical smear result. Psychooncology 21, 1071\u20131081 (2012).","journal-title":"Psychooncology"}],"container-title":["Nature Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41591-023-02600-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-023-02600-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-023-02600-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T11:17:33Z","timestamp":1702466253000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41591-023-02600-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":84,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["2600"],"URL":"https:\/\/doi.org\/10.1038\/s41591-023-02600-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-2392647\/v1","asserted-by":"object"}]},"ISSN":["1078-8956","1546-170X"],"issn-type":[{"value":"1078-8956","type":"print"},{"value":"1546-170X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]},"assertion":[{"value":"19 December 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 September 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 December 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"K.S. received salary support from the Cancer Institute NSW (Australia, grant no. CDF1004). M.A. was supported by the Horizon 2020 Framework Programme for Research and Innovation of the European Commission, through the RISCC Network (grant no. 847845). K.C. receives salary support from the National Health and Medical Research Council (Australia, grant no. APP1135172). K.C. is co-principal investigator and M.C. is an investigator on an investigator-initiated trial of cytology and primary HPV screening in Australia (\u2018COMPASS\u2019) (\n                      \n                      and\n                      \n                      ), which is conducted and funded by the Australian Centre for the Prevention of Cervical Cancer, a government-funded health promotion charity. The Australian Centre for the Prevention of Cervical Cancer has received equipment and a funding contribution for the COMPASS trial from Roche Molecular Systems and operational support from the Australian Government. K.C. is also co-principal investigator on a major implementation program, Elimination of Cervical Cancer in the Western Pacific, which receives support from the Minderoo Foundation and equipment donations from Cepheid, Inc. The remaining authors declare no competing interests. All funders declared here had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}