Predicting Cohort-Specific Cervical Cancer Incidence From Population-Based Surveys of Human Papilloma Virus Prevalence: A Worldwide Study

Abstract

Predictions of cervical cancer burden and the impact of measures taken to control this cancer are usually data-demanding and based on complex assumptions. We propose a predictive method (called PANDORA) based on human papillomavirus (HPV) prevalence, measured 1993-2008, and cervical cancer incidence (CCI), measured 1993-2012, in the same birth cohorts from different worldwide locations, informed by data on age at detection of high-risk HPV and sexual debut. The model can predict CCI among high-risk HPV-positive women and predict CCI up to 14 years following high-risk HPV detection. We found CCI to increase during the 14 years following high-risk HPV detection in unscreened women aged <35 years but to remain mainly constant among women ≥35 years. Age at sexual debut was a significant modifier of CCI. Using our model, we accurately reproduced CCI among high-risk HPV-positive women as observed in cohort studies and in the general population of multiple countries. We also predicted the annual number of cervical cancer cases and CCI in locations with HPV prevalence data but no cancer registry. These findings could inform cervical cancer control programs in settings without cancer registries, as they can be used to predict future cervical cancer burden from population-based surveys of HPV prevalence.

Keywords: forecasting; papillomavirus infections; uterine cervical neoplasms.

Figure 1

Birth cohort–specific high-risk human papillomavirus (HR HPV) prevalence and cervical cancer incidence rates, multiple countries. Results are shown by age group at HPV detection, time lag between HR HPV prevalence measurement (1993–2008; International Agency for Research on Cancer HPV Prevalence Surveys) and cervical cancer detection (2008–2012; Cancer Incidence in Five Continents Volume XI), and location. The lines represent effect estimates obtained fitting a Poisson regression model. Cervical cancer incidence rate is given per 100,000 woman-years. A) Ages 25–34 years; B) ages 35–44 years; C) ages 45–54 years; D) ages 55–64 years.

Figure 2

Cervical cancer incidence rates (1993–2012) in high-risk human papillomavirus (HR HPV)-positive women, PANDORA model, multiple countries. Results are shown by years since high-risk HPV detection (1993–2008), age group at HPV detection, screening implementation status and location. Model-based projections were drawn assuming the following average age at sexual debut 18.0 years (ages 20–24 years), 19.7 (ages 25–34 years), 20.1 (ages 35–44 years), and 20.5 (ages 45–54 years). Cervical cancer incidence rate is given per 100,000 woman-years. A) Ages 25–34 years; B) ages 35–44 years; C) ages 45–54 years; D) ages 55–64 years.

Figure 3

Cervical cancer incidence rates (1993–2012) in high-risk human papillomavirus (HR HPV)-positive women in locations without screening, PANDORA model, multiple countries. Results are shown by years since HR HPV detection (1993–2008), age–group at HR HPV detection, average age at sexual debut, and location. Cervical cancer incidence rate is given per 100,000 woman-years. A) Ages 25–34 years; B) ages 35–44 years; C) ages 45–54 years; D) ages 55–64 years.