Reducing Harms and Increasing Benefits of Screening for Cervical Cancer and Colorectal Cancer – A Model-based Approach

Screening is the systematic testing of asymptomatic individuals to identify disease or risk factors for disease. This enables the possibility to act earlier, e.g. by starting treatment of the disease earlier. Screening is especially valuable for diseases like cancer, where prognosis is better in earlier stages. Cervical cancer and colorectal cancer can even be prevented by screening, as their development is usually preceded by a long preclinical phase in which benign lesions can be detected by screening and removed by subsequent treatment. Obviously, this will reduce morbidity and mortality from these types of cancer. However, screening also comes with burden and harm for some of its participants. Undergoing a screening examination can be painful, may lead to complications, and the result is never 100% accurate, meaning that disease will be missed in some individuals while others will unnecessarily be referred for follow-up testing and potentially also treatment. Reducing these harms and further increasing the benefits of screening for cervical cancer and colorectal cancer is the topic of this thesis. Several studies are included in which mathematical modeling has been used to assess the harms, benefits, and harm-benefit ratio of different screening strategies for the early detection of cervical cancer and colorectal cancer.

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