LAUSR

Vänskä et al. (Am J Epidemiol. XXXX;XXX(XX):XXXX-XXXX)) provide us with cohort lifetime risks of cervical cancer attributable to different human papillomavirus (HPV) types in Sweden. We argue that a standardized lifetime risk such as those calculated by Vänskä et al. might be a more appropriate public health target for cervical cancer elimination than age-standardized incidence rates. Age-standardization to an arbitrary standard age distribution implies an implicit value choice regarding the weight of different age groups for which we find little moral justification. Conversely, a standardized lifetime risk uses a standard life expectancy as weights, corresponding to the likelihood that cervical cancer would impact a woman and prevent her from pursuing opportunities within a standard lifespan. Based on the data from Vänskä et al., a standardized lifetime risk of 129-250 cervical cancers per 100,000 women born could be an aspirational alternative public health target for cervical cancer elimination as a public health problem, complementary to the World Health Organization's arbitrary draft target of 4 cervical cancers per 100,000 age standardized women-years.