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CervicalCheck should change primary screening method to HPV testing says HIQA

The Health Information and Quality Authority (HIQA) has advised that CervicalCheck, Ireland’s national cervical screening programme,  should  change its primary screening method to HPV testing. HIQA carried out a health technology assessment (HTA) to assess the impact of changing from the current policy of primary screening with liquid-based cytology to primary screening with HPV testing.

They found that switching to primary HPV testing would reduce the number of screenings each woman has in her lifetime, while providing improving accuracy in detecting precancerous abnormalities and early stage invasive cervical cancer.

HIQA’s Director of Health Technology Assessment and Deputy Chief Executive Dr Máirín Ryan said: “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”.HIQA claim that implementing primary HPV screening five-yearly, between the ages of 25 and 60, would mean two fewer screening tests over a woman’s lifetime, while women would experience no change in how the cervical screening sample is collected.

Twenty per cent more precancerous abnormalities would be detected and 30 per cent more cervical cancer cases and deaths would be avoided, compared with the current screening strategy.

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. Although at lower risk of developing cervical cancer, they are advised to attend regular cervical screening, as the current vaccine does not protect against all virus types that can lead to cervical cancer.