Journal
MEDICAL DECISION MAKING
Volume 30, Issue 1, Pages 84-98Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/0272989X09336140
Keywords
cervical intraepithelial neoplasms; mathematical model; Markov process; papillomavirus infections; uncertainty
Funding
- Department of Health, England [DOH 0390030, 0390031]
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A Markov model was constructed in order to estimate typespecific rates of cervical lesion progression and regression in women with high-risk human papillomavirus (HPV). The model was fitted to age- and type-specific data regarding the HPV DNA and cytological status of women undergoing cervical screening in a recent screening trial, as well as cervical cancer incidence. It incorporates different assumptions about the way lesions regress, the accuracy of cytological screening, the specificity of HPV DNA testing, and the age-specific prevalence of HPV infection. Combinations of assumptions generate 162 scenarios for squamous cell carcinomas and 54 scenarios for adenocarcinomas. Simulating an unscreened cohort of women infected with high-risk HPV indicates that the probability of an infection continuing to persist and to develop into invasive cancer depends on the length of time it has already persisted. The scenarios and parameter sets that produce the best fit to available epidemiological data provide a basis for modeling the natural history of HPV infection and disease.
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