Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 190, Issue 4, Pages 515-518Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwaa120
Keywords
age distribution; age of onset; disease eradication; mass screening; papillomavirus infections; public health; uterine cervical neoplasms
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Research suggests that standardized lifetime risk may be a more appropriate public health target for cervical cancer elimination. Age-standardized incidence rates have limitations compared to standardized lifetime risk.
In their accompanying article, Vanska et al. (Am J Epidemiol. 2021;190(4):506-514) provide us with cohort lifetime risks of cervical cancer attributable to different types of human papillomavirus in Sweden. We argue that a standardized lifetime risk such as those calculated by Vanska et al. might be a more appropriate public health target for cervical cancer elimination than age-standardized incidence rates. Age standardization to an arbitrary standard age distribution implies an implicit value choice regarding the weight of different age groups for which we find little moral justification. Conversely, a standardized lifetime risk uses standard life expectancy as a weight, corresponding to the likelihood that cervical cancer would impact a woman and prevent her from pursuing opportunities within a standard life span. Based on the data from Vanska et al., a standardized lifetime risk of 129-250 cervical cancers per 100,000 women born could be an aspirational alternative public health target for cervical cancer elimination as a public health problem, complementary to the World Health Organization's arbitrary draft target of 4 cervical cancers per 100,000 age-standardized woman-years.
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