Impact of screening for HPV-positive oropharyngeal cancers: A microsimulation-based modeling study

Published

February 6, 2025

Author(s)

Rebecca Landy, Gregory Haber, Barry Graubard, Carole Fakhry, Nicole Campos, Emily Burger, Li Cheung, Hormuzd Katki, Maura Gillison, Anil Chaturvedi

Abstract

Purpose: We estimated the population-level impact of screening on morbidity and mortality of HPV16-positive oropharyngeal cancer among US men aged 45-79 years. Methods: We developed an individual-level, state-transition natural history microsimulation model to estimate the impact of screening using state-of-the-science performance estimates for oral HPV16 detection, HPV16 E6 antibody detection, and transcervical ultrasound of neck and oropharynx. We modeled and compared clinical detection to counterfactual screen detection for cancer stage, single- vs. multiple-modality treatment, and survival. Screening scenarios compared four progression speeds across cancer stages (very slow, slow, fast, and very fast) and four frequencies (once, every 5-years, every 3-years, and annually). Results: Among birth cohorts of US men aged 45-79 years in 2021, 163,958 incident clinically diagnosed HPV-positive oropharyngeal cancers and 32,009 deaths would occur through age 84 years. Assuming very fast progression across cancer stages, 4%, 20%, 31%, and 60% of these cancers would be detected by one-off, 5-yearly, 3-yearly, and annual screening. Annual screening (very fast progression) could reduce the number of cancers diagnosed at advanced stages (AJCC v7, Stages III/IV: 90.0% with no screening vs. 59.1%) and treated by multiple-modalities (80.6% with no screening vs. 50.6%). Cancer mortality would also be reduced by 36.2%, with a gain of 106,000 life-years. Annual screening would require screening 561 men per screen-detected cancer, 1,118 per additional cancer treated by single-modality, 4,740 per death prevented, and 520 per life-year gained. Annual lifetime screening would entail individuals receiving an average of 1.01 biomarker screens and 14.4 ultrasounds. Conclusions: If proven efficacious in randomized trials and cost-effective, screening for HPV-positive oropharyngeal cancers could provide substantial population-level reductions in advanced stage cancers, treatment-related morbidities, and mortality.

Citation

Journal of the National Cancer Institute

Pub Type

Journals

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https://doi.org/10.1093/jnci/djaf033

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Citation

Landy, R. , Haber, G. , Graubard, B. , Fakhry, C. , Campos, N. , Burger, E. , Cheung, L. , Katki, H. , Gillison, M. and Chaturvedi, A. (2025), Impact of screening for HPV-positive oropharyngeal cancers: A microsimulation-based modeling study, Journal of the National Cancer Institute, [online], https://doi.org/10.1093/jnci/djaf033, https://tsapps.nist.gov/publication/get_pdf.cfm?pub_id=958384 (Accessed October 9, 2025)