Primary HPV-based cervical cancer screening in Europe: implementation status, challenges, and future plans

Abstract

Background: Cytology-based screening has been a cornerstone of cervical cancer prevention for decades. Following extensive evidence demonstrating higher sensitivity and accuracy, lower variability and better reproducibility of human papillomavirus (HPV)-based screening compared with conventional or liquidbased cytology, recent European guidelines strongly recommend primary HPV-based screening over standard cytology-based screening. In addition, HPV-based screening offers the possibility of selfsampling and makes possible longer screening intervals in women with negative screening results. Objectives: We summarize the current status of implementation of HPV-based screening in Europe, describe the real-life experience and challenges from countries already performing HPV-based screening, and briefly review immediate and long-term plans for screening implementation in selected European countries. Sources: Data were obtained from peer-reviewed literature, personal communication with experts and authorities involved in formulating national recommendations and practical guidelines, and relevant national websites. Content: As of July 2019, the Netherlands and Turkey are the only European countries with fully implemented national HPV-based cervical cancer screening. Italy, Sweden and Finland have already implemented HPV-based screening in several regions, and several other countries are at various stages of implementation. Some countries are considering transitioning from cytology-based to HPV-based screening, but are struggling with the suboptimal performance of current population-based programmes. Implementation of HPV-based screening has resulted in higher colposcopy referral rates, but also higher detection rates of CIN3þ lesions and cervical cancers requiring immediate treatment. Cytology is mostly used as a triage test, although other strategies are under consideration in some countries. Implications: HPV-based screening is best suited in organized population-based screening settings. In 2019, cervical cancer screening policies across Europe vary greatly. Experience in countries with national and regional HPV-based screening already implemented is generally very positive. Urgent action is needed in many European countries, especially those with suboptimal opportunistic cytology-based cervical cancer screening.

Detection of high‐grade cervical disease among women referred directly to colposcopy after a positive HPV screening test varies with age and cytology findings

“…1 A number of different algorithms and management pathways are currently under consideration or in use in different countries. 14,15 The high predictive value reported in our study supports the value of this approach in the Australian setting.…”

Methylation markers FAM19A4 and miR124‐2 as triage strategy for primary human papillomavirus screen positive women: A large European multicenter study

“…With superior sensitivity for ≥CIN2 detection and an improved protection against cervical cancer, high-risk human papillomavirus (hrHPV) based cervical screening has replaced or is scheduled to replace cytology as primary screening method in several countries with several other expected to follow shortly. [1][2][3][4][5][6][7] To stratify hrHPV screen positive women with clinical disease from women with transient HPV infections, cytology-based triage with or without HPV16…”

Evaluation of the concordance in HPV type between self- and physician-collected samples using a brush-based device and a PCR-based HPV DNA test in Japanese referred patients with abnormal cytology or HPV infection

“…Primary physician-collected HPV screening every 5 years with partial genotyping is predicted to be substantially more effective and potentially cost-saving relative to current cytology screening programs undertaken every 2 years [7]. The Netherlands and Turkey fully implemented national HPV-based cervical cancer screening [8].…”