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HIQA advocates move to HPV testing as primary cervical screening method

Today’s HTA of HPV testing as the primary screening method for prevention of cervical cancer found that changing to primary HPV testing would reduce the number of screenings each woman has in her lifetime, while providing better accuracy in detecting precancerous abnormalities and early stage invasive cervical cancer. Women would experience no change in how the cervical screening sample is collected.

HIQA’s Director of Health Technology Assessment and Deputy Chief Executive Dr Máirín Ryan said: “HPV infection is associated with almost all cervical precancerous abnormalities and invasive cervical cancers. Compared with the current screening strategy, primary HPV screening is a better test which allows all women who participate in cervical screening to become aware of their current HPV status and those who are at higher risk of cervical cancer to be picked up earlier.”

“Where a woman is found to be HPV-positive following primary HPV screening, a follow-up test using liquid-based cytology will be carried out on that same sample to inspect for cellular abnormalities. If any abnormalities are detected, a more detailed examination of the cervix (colposcopy) is needed. Women with a negative HPV test can be reassured that they are at very low risk of developing precancerous abnormalities in the next five years. For this reason, we advise that the interval between screenings can be increased to every five years for those currently being screened three-yearly. A change to primary HPV screening means the same benefit is provided to women in fewer screenings.”

Implementing primary HPV screening five-yearly from age 25 to age 60 would lead to two fewer screening tests over a woman’s lifetime. Twenty per cent more precancerous abnormalities would be detected and 30 per cent more cervical cancer cases and deaths would be avoided for every screening test carried out compared with the current screening strategy.

“As HPV infection is more common in younger women, women who have not been vaccinated against HPV and who are aged between 25 and 30 years may benefit from three-yearly screening to ensure they are protected.”

Dr Ryan continued: “CervicalCheck began in 2008 and there has been good uptake with four in five eligible women up to date with their smear tests. However, this decreases with age. For this reason, HIQA advises that cervical screening may be extended up to 65 years of age for women who have only had the benefit of routine cervical screening from age 50. While this would come with an increased cost, it would provide additional clinical benefit for these women.”

In 2018, the first women vaccinated against HPV 16 and HPV 18 as part of the national school-based immunisation programme will become eligible for CervicalCheck. These women are at lower risk of developing cervical cancer.

However, as the current vaccine does not protect against all virus types that can lead to cervical cancer, vaccinated women should still attend for regular cervical screening.

Dr Ryan said: “Vaccinated women should be screened every five years with HPV testing, as it is the best strategy in this group.

CervicalCheck has welcomed the publication of the HTA. Dr Grainne Flannelly, Clinical Director, CervicalCheck noted: “Using newer tests in a different way could help prevent more cancers and have the additional benefit of reducing unnecessary tests for most women.”

Dr Flannelly continued: “Around 277 women develop cervical cancer in Ireland each year and 88 women die from the disease. The average age of diagnosis is 46 years and the average age of death from the disease is 56 years. The rates are higher than many other European countries but in the three years to 2014 the numbers have started to drop in Ireland.”

Discussions on how and when to implement a change in the cervical screening technology will take place between the Department of Health, the HSE and the National Screening Service over the course of the coming months.

Meanwhile, the Irish Cancer Society said a move to HPV testing would be a welcome step in the battle against cervical cancer.

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