Public health impact of increasing human papillomavirus vaccination and cervical cancer screening: A US state-level decision analysis

Background: Cervical cancer poses a substantial burden in the United States. State-level decision makers need to understand the expected benefits of implementing interventions to reduce this burden. This study aimed to estimate the long-term state-level benefits of interventions to reduce the burden of cervical cancer. Methods: We used a simulation model to estimate the expected reductions in cervical cancer incidence and mortality by achieving 80% (or 90%) vaccination coverage among adolescents aged 13-17 years by 2030 and increasing screening uptake by 5% among women aged 21-65 years across all 50 US states who had never been screened. We modeled 1 status quo scenario and 3 intervention scenarios: increasing vaccination only, increasing screening only, and increasing both vaccination and screening. The benefits of each intervention were presented as the cumulative reduction in cancer incidence and mortality compared with the status quo over a 100-year analytic period. Results: Compared with the status quo, the cumulative reduction from the “increase in vaccination coverage only” scenario varied substantially by state, generally being higher in Southern and Western states. The greatest reductions were predicted for Mississippi, with 253.1 cases and 80.0 deaths per 100000 women. The “increase in both vaccination and screening” scenario reduced cancer incidence from 9.2 (Utah) to 266.0 (Mississippi) per 100000 women and reduced mortality from 3.3 (Utah) to 85.0 (Mississippi) per 100000 women. Conclusion: Our modeling study suggests that states and regions will differ in the extent to which they will benefit from increasing human papillomavirus vaccination coverage and cervical cancer screening uptake.