The Benefit-Harm Frontier of Different Primary Screening Strategies for Cervical Cancer in Germany

Using a benefit-harm frontier (BHF) approach, we systematically compared benefits and harms of different HPV- and cytology-based primary cervical cancer screening strategies in Germany. A previously validated and published Markov modelwas used to analyze the trade-off between benefits and harms of different screening strategies differing by length of screening interval and test algorithms, including cytology alone, HPV testing alone, in combination with cytology or with cytological triage of HPV-positives. We used published German clinical, epidemiological and international test accuracy data from meta-analyses. Predicted outcomes included reduction in cervical cancer incidence and unnecessary treatment (defined as conizations of lesions