Shalini L Kulasingam

University of Minnesota Duluth, Duluth, Minnesota, United States

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Publications (63)470.2 Total impact

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    Erik J. Nelson · John Hughes · J Michael Oakes · James S Pankow · Shalini L Kulasingam
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    ABSTRACT: Objectives To identify factors associated with human papillomavirus (HPV) vaccination and to determine the geographic distribution of vaccine uptake while accounting for spatial autocorrelation. Design This study is cross-sectional in design using data collected via the Internet from the Survey of Minnesotans About Screening and HPV study. Setting and participants The sample consists of 760 individuals aged 18–30 years nested within 99 ZIP codes surrounding the downtown area of Minneapolis, Minnesota. Results In all, 46.2% of participants had received≥1 dose of HPV vaccine (67.7% of women and 13.0% of men). Prevalence of HPV vaccination was found to exhibit strong spatial dependence () across ZIP codes. Accounting for spatial dependence, age (OR=0.76, 95% CI 0.70 to 0.83) and male gender (OR=0.04, 95% CI 0.03 to 0.07) were negatively associated with vaccination, while liberal political preferences (OR=4.31, 95% CI 2.32 to 8.01), and college education (OR=2.58, 95% CI 1.14 to 5.83) were found to be positively associated with HPV vaccination. Conclusions Strong spatial dependence and heterogeneity of HPV vaccination prevalence were found across ZIP codes, indicating that spatial statistical models are needed to accurately identify and estimate factors associated with vaccine uptake across geographic units. This study also underscores the need for more detailed data collected at local levels (eg, ZIP code), as patterns of HPV vaccine receipt were found to differ significantly from aggregated state and national patterns. Future work is needed to further pinpoint areas with the greatest disparities in HPV vaccination and how to then access these populations to improve vaccine uptake.
    Full-text · Article · Aug 2015 · BMJ Open
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    ABSTRACT: Predictors of PCR positivity for pertussis were assessed using Minnesota active surveillance data. Report of an exposure to pertussis and testing within the optimal time frame of ≤2 weeks were significantly associated with testing PCR positive, emphasizing the importance of asking about epidemiological factors when assessing patients for pertussis, and timely PCR testing.
    No preview · Article · Jul 2015 · The Pediatric Infectious Disease Journal
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    ABSTRACT: We examined the impact of undetected infections, adult immunity, and waning vaccine-acquired immunity on recent age-related trends in pertussis incidence. We developed an agent-based model of pertussis transmission in Dakota County, Minnesota using case data from the Minnesota Department of Health. For outbreaks in 2004, 2008, and 2012, we fit our model to incidence in 3 children's age groups relative to adult incidence. We estimated parameters through model calibration. The duration of vaccine-acquired immunity after completion of the 5-dose vaccination series decreased from 6.6 years in the 2004 model to approximately 3.0 years in the 2008 and 2012 models. Tdap waned after 2.1 years in the 2012 model. A greater percentage of adults were immune in the 2008 model than in the 2004 and 2012 models. On average, only 1 in 10 adult infections was detected, whereas 8 in 10 child infections were detected. The observed trends in relative pertussis incidence in Dakota County can be attributed in part to fluctuations in adult immunity and waning vaccine-acquired immunity. No single factor accounts for current pertussis trends. (Am J Public Health. Published online ahead of print July 16, 2015: e1-e6. doi:10.2105/AJPH.2015.302794).
    No preview · Article · Jul 2015 · American Journal of Public Health
  • George F Sawaya · Shalini Kulasingam · Thomas D. Denberg · Amir Qaseem
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    ABSTRACT: The purpose of this best practice advice article is to describe the indications for screening for cervical cancer in asymptomatic, average-risk women aged 21 years or older. The evidence reviewed in this work is a distillation of relevant publications (including systematic reviews) used to support current guidelines. Clinicians should not screen average-risk women younger than 21 years for cervical cancer. Clinicians should start screening average-risk women for cervical cancer at age 21 years once every 3 years with cytology (cytologic tests without human papillomavirus [HPV] tests). Clinicians should not screen average-risk women for cervical cancer with cytology more often than once every 3 years. Clinicians may use a combination of cytology and HPV testing once every 5 years in average-risk women aged 30 years or older who prefer screening less often than every 3 years. Clinicians should not perform HPV testing in average-risk women younger than 30 years. Clinicians should stop screening average-risk women older than 65 years for cervical cancer if they have had 3 consecutive negative cytology results or 2 consecutive negative cytology plus HPV test results within 10 years, with the most recent test performed within 5 years. Clinicians should not screen average-risk women of any age for cervical cancer if they have had a hysterectomy with removal of the cervix.
    No preview · Article · Apr 2015 · Annals of internal medicine
  • Hilary K. Whitham · Shalini L. Kulasingam
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    ABSTRACT: . We compare risk of cervical, colorectal, and breast cancer (and two pre-cancers: cervical intraepithelial neoplasia (CIN) grade 2/3 and colorectal adenomas) at and after the recommended ages to begin and end screening in the United States. . Surveillance, Epidemiology, and End Results data were used with Monte Carlo simulations to estimate risk at and after the ages to screen. . At the age to begin screening, absolute risk of breast and colorectal cancer was 381 and 53 times higher, respectively, than cervical cancer (0.0122, 95% CI: 0.0089-0.0162 and 0.0017, 95% CI: 0.0012-0.0023 vs. 3.2e(-5), 95% CI: 2.3e(-5)-4.3e(-5)). Risk of colorectal adenomas and breast cancer was 45 and 2.4 times higher than CIN 2-3 (0.2319, 95% CI: 0.1287-0.3624 and 0.0122, 95% CI: 0.0089-0.0017 vs. 0.0051, 95% CI: 0.0029-0.0081). After the age to end screening, breast and colorectal cancer risk was 17 and 11 times higher, respectively, than cervical cancer. . Risk of cervical cancer and pre-cancer at and after the recommended ages for screening is significantly lower than that of breast and colorectal cancer. Differences may become more pronounced in the era of HPV vaccines. Comparison of risk between cancers provides a novel perspective to inform future guideline development. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Apr 2015 · Preventive Medicine
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    Katy Kozhimannil · Eva Enns · Judith Kahn · Jill Farris · Shalini Kulasingam
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    ABSTRACT: Background: Rates of adolescent pregnancy and chlamydia infection vary considerably across communities. Our goal was to collaboratively create a broad framework for addressing teen sexual health, and to apply it by analyzing county-level predictors of pregnancy and chlamydia among adolescents. Methods: Framework development relied on data from structured focus group discussions in three high-risk communities. Using state-reported information on county teen pregnancy rates (among females 15-19, 2009-2011) and chlamydia rates (among females 15-19, 2012) together with a merged dataset of publicly-available, county-level information on behavioral and community measures, we conducted multivariate regression analyses for the 87 counties in Minnesota. Results: County rates of teen pregnancy and chlamydia varied widely, ranging from 7-101/1000 and from 558-4673/100,000, respectively. Factors independently associated with increased rates of teen pregnancy included lower contraceptive use among 12th grade males, a lower percentage of 12th graders who feel safe in their neighborhoods, a higher percentage of 9th graders who report feeling overweight, and county rates of single parenthood and age-adjusted mortality. Factors associated with elevated chlamydia rates were higher percentage of 12th graders who reported feeling overweight and who skipped school in the past month because they felt unsafe (p<0.05 for all comparisons reported). Conclusions: Much prior research and programming has focused on modifying individual behaviors to address teen sexual health, but communities cited broader issues of concern. This analysis identified community-level correlates, including adolescent self-image, community safety, family structure, and overall health. Addressing social determinants collaboratively with community members may hold promise for improving adolescent health.
    Full-text · Conference Paper · Nov 2014
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    ABSTRACT: Identifying co-occurring community risk factors, specific to rural communities, may suggest new strategies and partnerships for addressing sexual health issues among rural youth. We conducted an ecological analysis to identify the county-level correlates of pregnancy and chlamydia rates among adolescents in rural (nonmetropolitan) counties in Minnesota. Pregnancy and chlamydia infection rates among 15-19 year-old females were compared across Minnesota's 87 counties, stratified by rural/urban designations. Regression models for rural counties (n = 66) in Minnesota were developed based on publicly available, county-level information on behaviors and risk exposures to identify associations with teen pregnancy and chlamydia rates in rural settings. Adolescent pregnancy rates were higher in rural counties than in urban counties. Among rural counties, factors independently associated with elevated county-level rates of teen pregnancy included inconsistent contraceptive use by 12th-grade males, fewer 12th graders reporting feeling safe in their neighborhoods, more 9th graders reporting feeling overweight, fewer 12th graders reporting 30 min of physical activity daily, high county rates of single parenthood, and higher age-adjusted mortality (P < .05 for all associations). Factors associated with higher county level rates of chlamydia among rural counties were inconsistent condom use reported by 12th-grade males, more 12th graders reporting feeling overweight, and more 12th graders skipping school in the past month because they felt unsafe. This ecologic analysis suggests that programmatic approaches focusing on behavior change among male adolescents, self-esteem, and community health and safety may be complementary to interventions addressing teen sexual health in rural areas; such approaches warrant further study.
    No preview · Article · Oct 2014 · Journal of Community Health
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    ABSTRACT: Submission of vaginal samples collected at home could remove barriers that women face in getting screened for cervical cancer. From December 2013 to January 2014, women aged 21-30 years were recruited online to participate in either (1) self-collected testing for human papillomavirus (HPV) infection and an online survey, or (2) an online survey regarding their perceptions of self-collected testing for HPV infection. Demographics, risk factors, testing perceptions, and satisfaction with self-collected testing were assessed with online questionnaires. Women who performed self-collection were sent a home sampling kit by US mail, which was returned via US mail for HPV testing. A total of 197 women were enrolled, with 130 completing the online survey and 67 participating in both the survey and self-collection. Of the 67 women who were sent kits, 62 (92.5 %) were returned for testing. Sixty kits contained a sample sufficient for testing. The overall prevalence of HPV infection was 17.8 %, however 6 women (9.7 %) were infected with >1 type of HPV. Women who self-collected a sample reported more favorable attributes of self-collection compared to women who only participated in the online survey, including ease of sampling (87.1 vs. 18.9 %), no pain during sampling (72.6 vs. 5.6 %), and lack of embarrassment (67.7 vs. 12.9 %). A high prevalence of HPV infection was demonstrated among women recruited via the internet. Online recruitment and at home screening methods have the potential to engage women in screening by offering an approach that might be more acceptable to women of different backgrounds.
    Full-text · Article · Sep 2014 · Journal of Community Health
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    Erik J Nelson · John Hughes · J Michael Oakes · James S Pankow · Shalini L Kulasingam
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    ABSTRACT: Federally funded surveys of human papillomavirus (HPV) vaccine uptake are important for pinpointing geographically based health disparities. Although national and state level data are available, local (ie, county and postal code level) data are not due to small sample sizes, confidentiality concerns, and cost. Local level HPV vaccine uptake data may be feasible to obtain by targeting specific geographic areas through social media advertising and recruitment strategies, in combination with online surveys.
    Full-text · Article · Sep 2014 · Journal of Medical Internet Research
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    ABSTRACT: Objective: The goal of this pilot study was to evaluate adherence to the 2012 cervical cancer screening guidelines among health care providers in a large health maintenance organization. Study design: A cross-sectional survey evaluating knowledge, reported practices, and views of the 2012 cervical cancer screening guidelines was distributed to 325 health care providers within HealthPartners. The survey was divided into 3 sections: (1) provider demographics; (2) knowledge of the 2012 age-specific cancer screening guidelines; and (3) provider practice. Comparisons based on appropriate knowledge and practice of the guidelines were made using Fisher exact tests. Results: The response rate was 42%. Of 124 respondents, 15 (12.1%) reported they were not aware of the 2012 guideline changes. Only 7 (5.7%) respondents answered all the knowledge questions correctly. A majority of respondents reported correct screening practices in the 21-29 year patient age group (65.8%) and in the >65 year patient age group (74.3%). Correct screening intervals in the 30-65 year patient age group varied by modality, with 89.3% correctly screening every 3 years with Pap smear alone, but only 57.4% correctly screening every 5 years with Pap smear + human papillomavirus cotesting. The most frequently cited reasons for not adhering were lack of knowledge of the guidelines and patient demand for a different screening interval. Conclusion: Adherence to the 2012 cervical cancer screening guidelines is poor due, in part, to a lack of knowledge of the guidelines. Efforts should focus on improved provider and patient education, and methods that facilitate adherence to the guidelines such as electronic health record order sets.
    No preview · Article · Jun 2014 · American Journal of Obstetrics and Gynecology
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    Erik J. Nelson · John Hughes · Shalini L. Kulasingam
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    ABSTRACT: Human papillomavirus (HPV) infection in women is a concern because it is considered a necessary cause of cervical cancer. Male HPV infection is also an important concern, both for the HPV-associated cancer burden in men and for the risk of transmission to women. Effective screening programs have greatly reduced cervical cancer incidence and mortality. HPV vaccines are expected to further reduce the burden of cervical cancer and other HPV-related cancers. However, disparities in terms of screening and HPV vaccination exist across the United States. In order to accurately identify areas of disparity, the spatial distributions of HPV-associated cancers has to be determined. To date, the geographic distribution and pattern exhibited by all HPV-associated cancers that accounts for spatial dependence have not been analyzed at a local level (i.e. county or ZIP code). This study analyzed the spatial dependence and pattern of HPV-associated cancers in Minnesota from 1998 to 2007 using sparse spatial generalized linear mixed models and scan statistics for cluster detection. A strong clustering pattern was seen in the northern region of Minnesota for both men and women. Separate cluster analyses by gender identified areas of overlapping disease burden. The patterns observed in this analysis demonstrate the need to account for spatial dependence when analyzing disease rates for geographic areas (i.e. county or ZIP codes) since spatial analyses of HPV-associated cancers have the potential to identify areas with the highest HPV disease burden and may serve to uncover areas where policies and HPV vaccination strategies can be most beneficial.
    Full-text · Article · Jun 2014 · Spatial and Spatio-temporal Epidemiology
  • Shalini L Kulasingam · Laura J Havrilesky · Rahel Ghebre · Evan R Myers
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    ABSTRACT: This study addresses the following 3 questions posed by the US Preventive Services Task Force: (1) at what age should screening for cervical cancer begin; (2) at what age should screening for cervical cancer end; and (3) how do the benefits and potential harms of screening strategies that use human papillomavirus DNA testing in conjunction with cytology (cotesting) compare with those strategies that use cytology only? A Markov model was updated and used to quantify clinical outcomes (i.e., colposcopies, cancers, and life expectancy) associated with different screening strategies. Screening in the teenaged years is associated with a high number of colposcopies (harms), small differences in cancers detected and, as a result, small gains in life expectancy (benefits). Screening women beginning in the early 20s provides a reasonable balance of the harms and benefits of screening. Among women who have been screened according to the current recommendations for cervical cancer (beginning at age 21 years and conducted every 3 years with cytology), screening beyond 65 years is associated with small additional gains in life expectancy but large increases in colposcopies. For cotesting, a strategy of cytology only conducted every 3 years, followed by cotesting conducted every 5 years (for women ≥30 years), is associated with fewer colposcopies and greater gains in life expectancy compared with screening with cytology only conducted every 3 years. The results of this modeling study support current US Preventive Services Task Force recommendations for cervical cancer screening.
    No preview · Article · Apr 2013 · Journal of Lower Genital Tract Disease
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    ABSTRACT: Decision models are sometimes used alongside systematic reviews to synthesize evidence. Clarity, however, is lacking about when and how to conduct modeling studies in tandem with systematic reviews, as well as about how to evaluate and present model results. The objective of this study was to collect and analyze information from various sources to inform the development of a framework for deciding when and how a decision model should be added to a systematic review. We collected data through 1) review and analysis of evidence reports that used decision models; 2) review and synthesis of current best practices for the development of decision models; 3) interviews of Evidence-Based Practice Center directors and selected staff, United States Preventive Services Task Force members, and decision modelers who developed models used by the United States Preventive Services Task Force; and 4) a focus group of expert modelers. Models are well suited to address gaps in the literature, better suited for certain types of research questions, and essential for determining the value of information relating to future research. Opinions differ regarding whether model outputs constitute evidence, but interviewees expressed concern over the lack of standards and directions in grading and reporting such "evidence." Interviews of stakeholders and modelers revealed the importance of communication and presentation of model results as well as the importance of model literacy and involvement of stakeholders. The study demonstrates the need for a framework for deciding when and how to use models alongside systematic reviews and provides information to develop such a framework.
    Full-text · Article · Feb 2013 · Value in Health
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    ABSTRACT: Purpose: The purpose of this study is to provide guidance for determining when incorporating a decision-analytic model alongside a systemic review would be of added value for decisionmaking purposes. The purpose of systematic reviews is to synthesize the current scientific literature on a particular topic in the form of evidence reports and technology assessments to assist public and private organizations in developing strategies that improve the quality of health care and decisionmaking. However, there is often not enough evidence to fully address the questions that are relevant for decisionmakers. Decision models may provide added value alongside systematic reviews by adding a formal structure, which can be informed by the evidence. Methods: Our framework is informed by two sets of interviews and a focus group discussion; literature reviews to summarize best modeling practices and to profile the modeling literature; and an exploration of the feasibility of developing a database of published models. We interviewed Evidence-based Practice Center (EPC) members, some of whom have successfully incorporated models in EPC reports, to document lessons learned from those experiences. We also interviewed members of the U.S. Preventive Services Task Force (USPSTF) and cancer modelers who were involved in the recent efforts to use modeling with a systematic review to update USPSTF cancer screening guidelines, to evaluate the process of conducting a simultaneous systematic review and modeling exercise, and to evaluate stakeholder-perceived needs and whether needs were met. We reviewed and summarized the literature on best practices for modeling. This was supplemented by a focus group discussion with modeling experts to elicit, characterize, and precisely qualify best practices in decision and simulation modeling. These included: model formulation and characterization, model development and construction, handling and presentation of modeling assumptions, definition and presentation of parameters, outcomes to incorporate into the model, model analysis, model testing, validation, and implementation (including results presentation and communication). We developed a profile of the current modeling literature by conducting a systematic review of the medical literature and the grey literature to document publications that used a decision model and for what purpose (e.g., disease of interest, interventions evaluated). We also developed a prototype database to serve as a preliminary step in developing a resource that could be used to determine if, and how many, models exist on a particular disease of interest. Results: The resulting report consists of six chapters. Decision and Simulation Modeling Alongside Systematic Reviews provides an overview of models and describes the differences and synergies between systematic reviews and decision analysis. In Overview of Decision Models Used in Research, we provide a “scan” of the medical literature over the past 5 years in terms of the use of models in studies that compare intervention strategies using multiple sources of data. Use of Modeling in Systematic Reviews: The EPC Perspective documents the extent to which EPCs have incorporated models into data and presents results from key informant interviews with EPC members. We present a framework for deciding when a decision model can inform decisionmaking alongside a systematic review in Suggested Framework for Deciding When a Modeling Effort Should Be Added to a Systematic Review. Potential Modeling Resources explores several possible approaches to use when undertaking a modeling effort and discusses some of the challenges. Lastly, Best Practices for Decision and Simulation Modeling reviews the literature on best practices for modeling, supplemented by a focus group discussion with modeling experts, and lessons learned about the process of conducting a modeling exercise alongside a systematic review using recent experience with the USPSTF. Conclusions: We suggest a process for deciding when conducting a decision analysis in conjunction with a systematic review would be of value to decisionmakers.
    Full-text · Technical Report · Jan 2013
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    ABSTRACT: Over the last 5 years, prophylactic vaccination against human papillomavirus (HPV) in pre-adolescent females has been introduced in most developed countries, supported by modeled evaluations that have almost universally found vaccination of pre-adolescent females to be cost-effective. Studies to date suggest that vaccination of pre-adolescent males may also be cost-effective at a cost per vaccinated individual of ∼US$400-500 if vaccination coverage in females cannot be increased above ∼50%; but if it is possible, increasing coverage in females appears to be a better return on investment. Comparative evaluation of the quadrivalent (HPV16,18,6,11) and bivalent (HPV16,18) vaccines centers around the potential trade-off between protection against anogenital warts and vaccine-specific levels of cross-protection against infections not targeted by the vaccines. Future evaluations will also need to consider the cost-effectiveness of a next generation nonavalent vaccine designed to protect against ∼90% of cervical cancers. The timing of the effect of vaccination on cervical screening programs will be country-specific and will depend on vaccination catch-up age range and coverage and the age at which screening starts. Initial evaluations suggest that if screening remains unchanged, it will be less cost-effective in vaccinated compared to unvaccinated women but, in the context of current vaccines, will remain an important prevention method. Comprehensive evaluation of new approaches to screening will need to consider the population-level effects of vaccination over time. New screening strategies of particular interest include delaying the start age of screening, increasing the screening interval and switching to primary HPV screening. Future evaluations of screening will also need to focus on the effects of disparities in screening and vaccination uptake, the potential effects of vaccination on screening participation, and the effects of imperfect compliance with screening recommendations. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
    No preview · Article · Nov 2012 · Vaccine
  • Olusola Adegoke · Shalini Kulasingam · Beth Virnig
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    ABSTRACT: Purpose: To analyze trends in invasive cervical cancer incidence by age, histology, and race over a 35-year period (1973-2007) in order to gain insight into changes in the presentation of cervical cancer. Methods: Data from the nine Surveillance, Epidemiology, and End Results (SEER) registries that continuously collected information on invasive cervical cancer were analyzed for trends. Standardized to the 2000 U.S population, annual age-adjusted incidence rates were estimated by race and histologic subtype. Histologic subtype was classified into squamous, adenocarcinoma, and adenosquamous. Results: Overall incidence rates for invasive cervical cancer decreased by 54% over the 35 years, from 13.07/100,000 (1973-1975) to 6.01/100,000 (2006-2007), and the incidence rates declined by 51% and 70.2%, respectively, among whites and blacks. The incidence rates for squamous carcinoma decreased by 61.1% from 10.2/100,000 (1973-1975) to 3.97/100,000 (2006-2007). Incidence rates for adenosquamous cell carcinomas decreased by 16% from 0.27/100,000 (1973-1975) to 0.23/100,000 (2006-2007), and incidence rates for adenocarcinomas increased by 32.2% from 1.09/100,000 (1973-1975) to 1.44/100,000 (2006-2007). This increase in adenocarcinomas was due to an increase in incidence in white women; a decrease in incidence was observed for black women. Conclusions: Although marked reductions in the overall and race-specific incidence rates of invasive cervical cancer have been achieved, they mask important variation by histologic subtype. These findings suggest that alternatives to Pap smear-based screening, such as human papillomavirus (HPV) testing and HPV vaccination, need to be prioritized if adenocarcinomas of the cervix are to be controlled.
    No preview · Article · Jul 2012 · Journal of Women's Health
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    Thomas A Trikalinos · Shalini Kulasingam · William F Lawrence
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    ABSTRACT: Limited by what is reported in the literature, most systematic reviews of medical tests focus on "test accuracy" (or better, test performance), rather than on the impact of testing on patient outcomes. The link between testing, test results and patient outcomes is typically complex: even when testing has high accuracy, there is no guarantee that physicians will act according to test results, that patients will follow their orders, or that the intervention will yield a beneficial endpoint. Therefore, test performance is typically not sufficient for assessing the usefulness of medical tests. Modeling (in the form of decision or economic analysis) is a natural framework for linking test performance data to clinical outcomes. We propose that (some) modeling should be considered to facilitate the interpretation of summary test performance measures by connecting testing and patient outcomes. We discuss a simple algorithm for helping systematic reviewers think through this possibility, and illustrate it by means of an example.
    Preview · Article · Jun 2012 · Journal of General Internal Medicine
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    ABSTRACT: An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from 6 working groups, and a recent symposium cosponsored by the ACS, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, which was attended by 25 organizations. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (eg, the management of screen positives and screening intervals for screen negatives) of women after screening, the age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16 and HPV18 infections.
    No preview · Article · May 2012 · CA A Cancer Journal for Clinicians
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    ABSTRACT: An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from 6 working groups, and a recent symposium cosponsored by the ACS, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, which was attended by 25 organizations. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (eg, the management of screen positives and screening intervals for screen negatives) of women after screening, the age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16 and HPV18 infections.
    Full-text · Article · Apr 2012 · American Journal of Clinical Pathology
  • Shalini Kulasingam · Laura Havrilesky
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    ABSTRACT: In this chapter, we summarise findings from recent cost-effectiveness analyses of screening for cervical cancer and ovarian cancer. We begin with a brief summary of key issues that affect the cost-effectiveness of screening, including disease burden, and availability and type of screening tests. For cervical cancer, we discuss the potential effect of human papilloma virus vaccines on screening. Outstanding epidemiological and cost-effectiveness issues are included. For cervical cancer, this includes incorporating the long-term effect of treatment (including adverse birth outcomes in treated women who are of reproductive age) into cost-effectiveness models using newly available trial data to identify the best strategy for incorporating human papilloma virus tests. A second issue is the need for additional data on human papilloma virus vaccines, such as effectiveness of reduced cancer incidence and mortality, effectiveness in previously exposed women and coverage. Definitive data on these parameters will allow us to update model-based analyses to include more realistic estimates, and also potentially dramatically alter our approach to screening. For ovarian cancer, outstanding issues include confirming within the context of a trial that screening is effective for reducing mortality and incorporating tests with high specificity into screening into screening algorithms for ovarian cancer.
    No preview · Article · Dec 2011 · Best practice & research. Clinical obstetrics & gynaecology

Publication Stats

3k Citations
470.20 Total Impact Points

Institutions

  • 2010-2015
    • University of Minnesota Duluth
      • Medical School
      Duluth, Minnesota, United States
    • California State University, Sacramento
      Sacramento, California, United States
  • 2003-2013
    • Duke University
      • Center for Health Policy & Inequalities Research
      Durham, North Carolina, United States
  • 2005-2008
    • Duke University Medical Center
      • Department of Obstetrics and Gynecology
      Durham, North Carolina, United States
  • 2000-2004
    • University of Washington Seattle
      • Department of Epidemiology
      Seattle, Washington, United States