Abstract oral session 2014 World Cancer Congress

Accelerating Decision-Making with Microsimulation: The Adoption of Evidence in Cervical Cancer Screening  (#316)

Natalie R Fitzgerald 1 , Keiko Asakawa 2 , Andrew Coldman 3 , William K Evans 4 , William M Flanagan 2 , Steve Gribble , Gina Lockwood 1 , Saima Memon 1 , Anthony B Miller 5 , Claude Nadeau 2 , Cathy Popadiuk 6 , Michael C Wolfson 7
  1. Canadian Partnership Against Cancer, Toronto, ONTAR, Canada
  2. Statistics Canada, Ottawa, ON, Canada
  3. British Columbia Cancer Agency, Vancouver, BC, Canada
  4. Cancer Care Ontario, Toronto, ON, Canada
  5. University of Toronto, Toronto, ON, Canada
  6. Eastern Health, St. John's, Newfoundland, Canada
  7. University of Ottawa, Ottawa, ON, Canada

Background and Context:

Microsimulation models, such as the Partnership’s HPV Microsimulation Model (HPVMM) and Cancer Risk Management Model (CRMM), allow decision-makers to measure the effects of proposed interventions before they are implemented. This presents opportunities for accelerated and collaborative decision-making and coordinated cancer control strategies.


As the first cohort of HPV-vaccinated girls will turn 21 in 2016, we will soon face difficult questions about the value of cervical cancer screening in women. In vaccinated cohorts, we may be able to screen less, reducing the number of false-positives and over-treatment without negatively affecting population outcomes. Using the results of an HPVMM/CRMM case study, we will evaluate under what circumstances microsimulation modelling can support evidence-informed decision-making.


The HPVMM/CRMM will be used as a case study for its adoption and use in policy decision-making in Canada. in this analysis, we evaluated cervical cancer screening in vaccinated women. Our analysis compared current screening guidelines (21-69 x 3 years) with extended intervals (x 5 or x 10 years) or delayed start age (25- or 30-69). 

Programme/Policy Process:

Extending the interval of cervical cancer screening from every 3 years to 5 or 10 years was associated with a 20%-60% increase in the number of cervical cancer cases in Canada, respectively. Conversely, increasing the start age of screening from 21 to 25 or 30 was found to have no impact on the number of new cases. 

Outcomes/What was learned:

Microsimulation models such as the HPVMM and CRMM can be used to identify cost-effective strategies to prevent, screen and treat cervical cancer in Canada. More importantly, these findings must be translated more broadly to cancer control decision-makers to support evidence-based decision-making. This analysis, along with others, will be used to develop a framework to support the use of evidence and microsimulation modelling in cancer control decision-making.