Issues

The cover image is adapted from Figure 3 in the article, “Modeling the Balance of Benefits and Harms of Cervical Cancer Screening with Cytology and Human Papillomavirus Testing,” by Malagón and colleagues. The figure shows the cumulative lifetime net quality-adjusted life-years (QALY) gain and cervical cancer incidence by age and by number of 27 lifetime screens. In this study, the authors used a cervical cancer natural history Markov model calibrated to the Canadian context to examine different balance metrics to measure whether the benefits of cervical cancer screening outweigh its potential harms in unvaccinated women. Metrics were compared between cytology-based and human papilloma virus (HPV)–based screening strategies to assess which strategies may lead to a better balance between benefits and harms. Metrics using colposcopies as the main harm outcome favored cytology-based screening, whereas metrics based on screening tests and health preferences tended to favor HPV-based screening strategies. Whether HPV-based screening will improve the balance between benefits and harms of cervical cancer screening depends on how the balance between benefits and harms is assessed. For more information, see the article beginning on page 1436.