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-naive 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Norwegian Cancer Society [grant number 198073; PI: EAB]. The views expressed in this Article are those of the authors and do not necessarily represent the views of the Norwegian Cancer Society. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.