In future screening programmes, the frequency of screening will decrease because of vaccination. Triage algorithms for high-risk HPV positive women are also expected to change; many candidate triage tests are being evaluated including immunohistochemical tests and molecular tests (e.g. DNA methylation,microRNA). To assess the long-term impact of new screening and triage algorithms, mathematical models may need to be updated based on new insights into disease development. Two questions will be addressed: i) are current models ready to inform about long screening intervals for vaccinated cohorts? and ii) how does the discriminating ability of screening tests vary with the time since onset of HPV infection?
Logistic trait models will be applied to immunohistochemical, DNA methylation, and viral marker data to characterize the development of a precursor lesion.
Mathematical model predictions are iffy when informing about screening intervals beyond five years, because dwell times in the different precancerous states are uncertain. The discriminating ability of immunohistochemical and molecular tests strongly depends on the time since onset infection and early and late markers can be clearly identified. To evaluate the potential of a late marker as a primary or triage test, an update of current mathematical models seems recommendable.