***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background To provide quantitative insight into current U.S. policy choices for cervical cancer prevention , we developed a model of human papillomavirus ( HPV ) and cervical cancer , explicitly incorporating uncertainty about the natural history of disease . Methods We developed a stochastic microsimulation of cervical cancer that distinguishes different HPV types by their incidence , clearance , persistence , and progression . Input parameter sets were sample d r and omly from uniform distributions , and simulations undertaken with each set . Through systematic review s and formal data synthesis , we established multiple epidemiologic targets for model calibration , including age-specific prevalence of HPV by type , age-specific prevalence of cervical intraepithelial neoplasia ( CIN ) , HPV type distribution within CIN and cancer , and age-specific cancer incidence . For each set of sample d input parameters , likelihood-based goodness-of-fit ( GOF ) scores were computed based on comparisons between model-predicted outcomes and calibration targets . Using 50 r and omly re sample d , good-fitting parameter sets , we assessed the external consistency and face validity of the model , comparing predicted screening outcomes to independent data . To illustrate the advantage of this approach in reflecting parameter uncertainty , we used the 50 sets to project the distribution of health outcomes in U.S. women under different cervical cancer prevention strategies . Results Approximately 200 good-fitting parameter sets were identified from 1,000,000 simulated sets .  Modeled screening outcomes were externally consistent with results from multiple independent data sources . Based on 50 good-fitting parameter sets , the expected reductions in lifetime risk of cancer with annual or biennial screening were 76 % ( range across 50 sets : 69–82 % ) and 69 % ( 60–77 % ) , respectively . The reduction from vaccination alone was 75 % , although it ranged from 60 % to 88 % , reflecting considerable parameter uncertainty about the natural history of type-specific HPV infection . The uncertainty surrounding the model-predicted reduction in cervical cancer incidence narrowed substantially when vaccination was combined with every-5-year screening , with a mean reduction of 89 % and range of 83 % to 95 % . Conclusion We demonstrate an approach to parameterization , calibration and performance evaluation for a U.S. cervical cancer microsimulation model intended to provide qualitative and quantitative inputs into decisions that must be taken before long-term data on vaccination outcomes become available . This approach allows for a rigorous and comprehensive description of policy-relevant uncertainty about health outcomes under alternative cancer prevention strategies . The model provides a tool that can accommo date new information , and can be modified as needed , to iteratively assess the expected benefits , costs , and cost-effectiveness of different policies in the Background : In Italy , cervical cancer screening programmes actively invite women aged 25–64 years . Programmes are hindered by low participation . Methods : A sample of non-responder women aged 35–64 years , belonging to three different programmes ( in Rome , Florence and Teramo ) , was r and omly split into four arms : two control groups received st and ard recall letters to perform either Pap-test ( first group ) or human papillomavirus ( HPV ) test ( second group ) at the clinic . A third arm was sent letters offering a self- sample r for HPV testing , to be requested by phone , whereas a fourth group was directly sent the self- sample rs home . Results : Compliance with st and ard recall was 13.9 % ( N619 ) . Offering HPV test at the clinic had a nonsignificant effect on compliance ( N616 , relative risk (RR)=1.08 ; 95 % CI=0.82–1.41 ) . Self- sample r at request had the poorest performance , 8.7 % ( N622 , RR=0.62 ; 95 % CI=0.45–0.86 ) , whereas direct mailing of the self- sample r registered the highest compliance : 19.6 % ( N616 , RR=1.41 ; 95 % CI=1.10–1.82 ) . This effect on compliance was observed only in urban areas , Florence and Rome ( N438 , RR=1.69 ; 95 % CI=1.24–2.30 ) , but not in Abruzzo ( N178 , RR=0.95 ; 95 % CI=0.61–1.50 ) , a prevalently rural area . Conclusions : Mailing self- sample rs to non-responders may increase compliance as compared with delivering st and ard recall letters . Nevertheless , effectiveness is context specific and the strategy costs should be carefully considered Background : A r and omised trial to ascertain whether women who do not attend for cervical screening are more likely to respond to the opportunity to collect a self- sample for human papillomavirus ( HPV ) testing , or to a further invitation to attend for cervical screening . Methods : The study was carried out in a Primary Care Trust ( PCT ) in London between June 2009 and December 2009 . In total , 3000 women were r and omly selected from persistent non-responders ( i.e. , who had not responded to at least two invitations to attend for screening ) . The women were r and omised on a 1 : 1 basis to either receive an HPV self-sampling kit or a further invitation to attend for cervical cytology . The main outcome measures were ( 1 ) percentage of women attending for cervical cytology compared with those returning a self- sample HPV test or attending for cytology subsequent to receiving the kit and ( 2 ) percentage of those testing positive for HPV who attended further investigation . Results : The total response in the self-sampling group for screening was 10.2 % . Of the 1500 women in the control group sent a further invitation for cervical screening , 4.5 % attended for cytology screening . This difference is highly statistically significant ( P<0.0001 ) . Of the 8 women who tested positive for HPV , 7 attended for a cervical smear and had a concurrent colposcopy . Three of these ( 43 % ) had high- grade disease ( defined as CIN 2 + ) , with one found to have an invasive cancer ( stage 1b ) and one CIN 3 . Conclusions : The value of this intervention relies on the detection of high- grade CIN and early stage cancer with a good prognosis . The relatively high yield of abnormalities found is consistent with that expected among a hard to reach and relatively high-risk group of women . Our study suggests that self-sampling could increase participation among non-responders in Engl and , but further work is needed to ascertain whether the low response rate seen here is likely to be representative of the rest of the country . Other studies are needed to investigate the response to self-sampling in different demographic and geographic setting Objectives To examine sociodemographic predictors of  self-reported screening attendance  , intention to accept human papillomavirus ( HPV ) testing and willingness to accept  vaccination  for a daughter under 16 . Setting Home-based , computer-assisted interviews with a population representative sample of British women . Methods Participants were selected using r and om probability sampling of the Postcode Address File , 994 women aged 25–64 were included in these analyses . Women reported their attendance at cervical screening and intention to accept an HPV test . A sub sample of those with a daughter under 16 years ( n = 296 ) reported their willingness to  accept HPV vaccination  for their daughter . Results  Screening attendance  was associated with education level ( odds ratio [ OR ] = 1.66 , confidence interval [ 95 % CI ] : 1.07–2.56 ) and being married ( OR = 2.04 , 95 % CI : 1.37–3.03 ) . Acceptance of HPV testing was predicted by regular attendance for cervical screening ( OR = 1.58 , 95 % CI : 1.03–2.42 ) and being from a white background ( OR = 2.20 , 95 % CI : 1.18–4.13 ) . Daughter 's age was the only predictor of HPV vaccine acceptance , with mothers whose youngest daughter was 13–16 years old being the most likely to accept vaccination ( OR = 2.91 , 95 % CI : 1.27–6.65 ) . Conclusion In contrast to screening attendance , ethnicity plays an important role in HPV testing . Specific cultural barriers should be identified and addressed to ensure ethnic disparities in testing are limited . While marital status is associated with screening attendance , HPV testing could overcome this bias . Sociodemographic variables seem to play a limited role in HPV vaccine acceptance among mothers making vaccine decisions for their daughters , but as with other studies , age of daughter is important . The scientific reasons for vaccinating at 12–13 years should be emphasized in HPV information BACKGROUND Sexually transmitted human papillomavirus ( HPV ) high-risk types cause carcinoma and low-risk types lead to warts of genitoanal area . Since the HPV vaccine has been introduced , awareness of HPV infection , prevention and health-related behaviour have not been studied in a large sample of young women in Germany . OBJECTIVES Assessment of awareness and health-related behaviour regarding HPV infection and prevention among young German females . METHODS In 2010 , a postal cross-sectional survey was conducted with a r and om representative sample size ( n = 2000 ) of females aged 19 - 35 attending Germany 's largest ( comprehensive ) university , which was design ed to obtain data about socio-demographics , the awareness of sexually transmitted HPV , genitoanal neoplasms and their prevention , HPV vaccine , immunisation and cervical cancer screening . RESULTS Of the 547 ( 27.3 % ) participants , 69.1 % had heard of HPV , 62.5 % were aware of the vaccine , 14.4 % were vaccinated and 6.9 % reported a history of sexually transmitted infection , including HPV ( 2.7 % ) . The HPV-related knowledge among those who had heard of it was high ( 75.1 - 99.7 % ) , except of that HPV affects men ( 52.9 % ) and HPV 's causative role in genital ( 54.2 % ) and anal ( 35.6 % ) warts , and smoking ( 11.3 % ) as an HPV risk factor . The lower HPV knowledge score ( < median = 12 , ranged 1 - 17 ) was predicted by study ing social sciences/humanities ( OR = 3.68 , 95 % CI 1.99 - 6.79 ) and non-participation in cervical cancer screening ( OR = 2.04 , 95 % CI 1.02 - 4.07 ) . CONCLUSION This survey reveals an insufficient HPV awareness and low vaccination prevalence among young German women , underscoring the urgent need for HPV-related education aim ed at reducing the burden of HPV-induced genitoanal neoplasms BACKGROUND In four r and omised trials , human papillomavirus (HPV)-based screening for cervical cancer was compared with cytology-based cervical screening , and precursors of cancer were the endpoint in every trial . However , direct estimates are missing of the relative efficacy of HPV-based versus cytology-based screening for prevention of invasive cancer in women who undergo regular screening , of modifiers ( eg , age ) of this relative efficacy , and of the duration of protection . We did a follow-up study of the four r and omised trials to investigate these outcomes . METHODS 176,464 women aged 20 - 64 years were r and omly assigned to HPV-based ( experimental arm ) or cytology-based ( control arm ) screening in Sweden ( Swedescreen ) , the Netherl and s ( POBASCAM ) , Engl and ( ARTISTIC ) , and Italy ( NTCC ) . We followed up these women for a median of 6·5 years ( 1,214,415 person-years ) and identified 107 invasive cervical carcinomas by linkage with screening , pathology , and cancer registries , by masked review of histological specimens , or from reports . Cumulative and study -adjusted rate ratios ( experimental vs control ) were calculated for incidence of invasive cervical carcinoma . FINDINGS The rate ratio for invasive cervical carcinoma among all women from recruitment to end of follow-up was 0·60 ( 95 % CI 0·40 - 0·89 ) , with no heterogeneity between studies ( p=0·52 ) . Detection of invasive cervical carcinoma was similar between screening methods during the first 2·5 years of follow-up ( 0·79 , 0·46 - 1·36 ) but was significantly lower in the experimental arm thereafter ( 0·45 , 0·25 - 0·81 ) . In women with a negative screening test at entry , the rate ratio was 0·30 ( 0·15 - 0·60 ) . The cumulative incidence of invasive cervical carcinoma in women with negative entry tests was 4·6 per 10(5 ) ( 1·1 - 12·1 ) and 8·7 per 10(5 ) ( 3·3 - 18·6 ) at 3·5 and 5·5 years , respectively , in the experimental arm , and 15·4 per 10(5 ) ( 7·9 - 27·0 ) and 36·0 per 10(5 ) ( 23·2 - 53·5 ) , respectively , in the control arm . Rate ratios 
    Output:
    
RESULTS Knowledge about HPV and cervical cancer was lower in women with low socio-economic status and in disadvantaged groups .
A correct communication can reduce differences .
Longer intervals will make it easier to achieve high- population coverage , but higher cost of the test in private providers could reduce the use of opportunistic screening by disadvantaged women .
There are some evidence s that inviting for HPV test instead of Pap increases participation , but there are no data on social differences .
Self-sampling devices are effective in increasing participation and coverage .
Some studies showed that the acceptability of self-sampling  is higher in more educated women , but there is also an effect on hard-to-reach women .
Communication of HPV positivity may increase anxiety and impact on sexual behaviors , the effect is stronger in low educated and disadvantaged women .
Finally , many studies found indirect evidence that unvaccinated women are or will be more probably under-screened .
CONCLUSION The introduction of HPV test may increase population coverage , but non-compliance to protocol s and interaction with opportunistic screening can increase the existing inequalities