European guidelines for quality assurance in cervical cancer screening. Summary of the supplements on HPV screening and vaccination

Abstract

In a project coordinated by the International Agency for Research on Cancer (IARC) 31 experts from 11 European countries and IARC have developed supplements to the current European guidelines for quality assurance in cervical cancer screening. The supplements take into account the potential of primary testing for human papillomavirus (HPV) and vaccination against HPV infection to improve cervical cancer prevention and control and will be published by the European Commission in book format. They include 62 recommendations or conclusions for which the strength of the evidence and the respective recommendations is graded. While acknowledging the available evidence for more efficacious screening using HPV primary testing compared to screening based on cytology, the authors and editors of the supplements emphasize that appropriate policy and programme organization remain essential to achieve an acceptable balance between benefit and harm of any screening or vaccination programme. A summary of the supplements and all of the graded recommendations are presented here in journal format to make key aspects of the updated and expanded guidelines known to a wider professional and scientific community.

VALGENT: A protocol for clinical validation of human papillomavirus assays

“…The VALGENT objectives are in agreement with priorities defined by the World Health Organisation [13] and new European Guidelines in Quality Assurance in Cervical Cancer Screening, which are currently in press [6,14,15].…”

“…Several countries have recently switched towards HPV-based screening or are in the process of planning this change [15,40,41]. Enrolment of study subjects will therefore include a consecutive series of women participating in HPV-based cervical cancer screening enriched with HPV positive women.…”

Relevance of the Pap Test: A Report of HPV-DNA Test-Negative High-Grade Squamous Intraepithelial Lesions of the Female Lower Genital Tract

“…Concurrent testing (cotesting) with both the HPV-DNA assay and cytology is presently recommended by most societies in the USA but not in Europe [11,26]. Primary screening with only HPV testing has been challenged by some authors who have highlighted the improved detection by cotesting and suggested it is insufficiently sensitive alone [19,27,28,29].…”

Epidemiology and Early Detection of Cervical Cancer

“…In Europe, the majority of countries adhere to the recommended screening interval of 3-5 years; however, in some countries (Germany, Austria, and Luxembourg) screening is carried out every year. Current European guidelines from 2015 emphasize that despite the convincing evidence for more efficacious screening using HPV primary testing, appropriate screening policy and program organization are essential to achieving an acceptable balance between benefits and harms of any screening program [20]. These principles are particularly important in HPV primary screening in order to avoid substantial increases in the number of women with positive test results leading to additional colposcopies and treatment in the absence of any additional benefit for participants.…”