Jeanne S. Mandelblatt, M.D., M.P.H., and colleagues used a mathematical model of the natural history of cervical cancer to estimate incremental societal costs and benefits of screening the average U.S. population with testing for the human papillomavirus alone or in combination with a Pap smear compared with the standard of Pap smears alone.

According to background information cited in the article, about 50 million Pap smears are performed annually in the U.S. However, the false-negative rate is estimated at 25 to 50 percent. Increased understanding of the role of human papillomavirus infection in development of cervical cancer and advances in viral technology have prompted exploration of virus testing as an adjunct or primary screening tool.

The authors compared 18 general population screening strategies: Pap smear plus virus testing, Pap smear alone, and virus testing alone at intervals of two or three years among hypothetical groups of U.S. women, beginning at age 20 years and continuing to age 65 years, 75 years, or death.

"Using a comprehensive simulation model of the natural history of human papillomavirus-driven cervical carcinogenesis, we found that comparing each strategy to the next least-expensive option, maximal savings in life could be achieved by screening every two years from age 20 to death with a combination of human papillomavirus and Pap tests," the authors write.

"Cessation of screening at age 65 or 75 years is less expensive and captures 86.6 percent and 97.8 percent of the benefits of lifetime biennial screening, respectively," they report. "Applying age limits to screening is a viable option to maintain benefits while reducing costs," they suggest.

The authors found that virus screening alone was equally effective as Pap testing alone at any given screening interval or age of screening cessation, but it was more costly. "In sensitivity analyses, human papillomavirus testing would be more effective and less costly than Pap testing at a cost threshold of five dollars for a human papillomavirus test," they write.

"Regardless of modality chosen, the greatest health gains from screening will depend on reaching all women and ensuring access to diagnosis after an abnormal screening result (and treatment, if malignant)," the authors conclude.