The Health Information and Quality Authority (HIQA) has advised that Ireland's national cervical screening programme changes its primary screening method to HPV testing.

An assessment carried out by the authority 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.

As well as that, young women who did not avail of the cervical cancer vaccine may benefit from screenings every three years.

HIQA carried out a health technology assessment (HTA) to assess the impact of changing CervicalCheck's current policy of primary screening with liquid-based cytology to primary screening with HPV testing.

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.”

Main findings

Implementing primary HPV screening every five years from age 25 to age 60 would lead to:

• 2 fewer screening tests over a woman’s lifetime

• 20% more precancerous abnormalities would be detected

• 30% 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."

Reaction

The Irish Cancer Society welcomed the findings of the assessment.

Commenting on the findings, Head of Research at the Irish Cancer Society and member of the Expert Advisory Group for this assessment Dr Robert O’Connor said:

“Since its introduction in 2008, CervicalCheck has provided a very successful screening programme that has undoubtedly saved lives. HIQA’s latest assessment, however, shows that the service can reach an even higher world-leading standard with the introduction of primary HPV testing.

“Young women and girls who have received the HPV vaccination are fully protected against the strains of HPV that cause seven in ten of all cervical cancers.

"It is important to note that, while significantly less likely to develop cervical cancer, availing of cervical screening – whether that is through the HPV test or the current liquid-based cytology process – is still recommended for these women so that any signs of the cancer can be spotted early and treated before they become a threat to their lives."

However, he added that should primary HPV testing be introduced, the system would not replace the HOV vaccination.

"Screening can detect cancerous and pre-cancerous cells, but treatment to remove these cells can be harsh and extremely invasive. What’s more, detection through screening is no guarantee of survival.

"Vaccination, on the other hand, can stop these cancerous cells from developing in the first place. It is guaranteed to save lives, and the more people who are vaccinated, the more effective it will be for the population at large."

The results of the HIQA assessment will be submitted to Ireland’s national cervical screening programme CervicalCheck and the Minister for Health for review.