Impact of ‘EVEN FASTER’ concept to accelerate cervical cancer elimination in Norway: A model-based analysis

Background Experts have proposed an ‘EVEN FASTER’ concept targeting age-groups maintaining circulation of human papillomavirus (HPV). We explored the effects of these proposals compared with cervical cancer (CC) screening-based interventions on age-standardized incidence rate (ASR) and CC elimination (<4 cases per 100,000 women) timing in Norway. Methods We used a model-based approach to evaluate alternative HPV vaccination and CC screening scenarios compared with a status-quo scenario reflecting previous vaccination and screening. For cohorts ages 25–35 years, we examined 11 vaccination scenarios that incrementally increased vaccination coverage from current cohort-specific rates. Each vaccination scenario was coupled with three alternative screening strategies that varied the frequency of HPV-based screening. Population- and cohort-level outcomes included ASR, lifetime risk of CC, and colposcopy referrals. Results Several vaccination strategies coupled with de-intensified screening frequencies lowered population ASR, but did not accelerate CC elimination unless incremental vaccination coverage reached ∼90% for vaccine-naïve cohorts. Alternative strategies that increased screening adherence could both accelerate elimination and improve ASR compared to status-quo. Conclusions An ‘EVEN FASTER’ campaign is unlikely to accelerate CC elimination but may reduce population-level ASR. Alternatively, targeting under- and never-screeners may both eliminate CC faster and lead to greater health benefits compared with vaccination-based interventions.