Hiqa recommends new cervical cancer screening method
Hiqa was asked by CervicalCheck, the HSE National Cervical Screening Programme, to evaluate the impact of changing the policy of primary screening with liquid-based cytology to primary screening with HPV testing.
Hiqa director of health technology assessment Dr Máirín Ryan said primary HPV screening would allow cervical cancer to be picked up earlier in women most at risk.
Dr Ryan said 20% more pre-cancerous abnormalities would be detected and 30% more cervical cancer cases and deaths would be avoided for every screening test carried out compared with the current testing strategy.
Where a woman was found to be HPV-positive, a follow-up test using liquid-based cytology will be carried out on the same sample to inspect for cellular abnormalities.
Implementing primary HPV screening five-yearly from age 25 to 60 would lead to fewer smear tests over a woman’s lifetime.
However, Hiqa recommends that women aged 25 to 30 who have not been vaccinated against HPV may benefit from three-yearly screening to ensure they are protected. The changes include extending screening up to 65 years for women who only benefited from routine screening from age 50.
Next year the first women vaccinated against HPV 16 and HPV 18 as part of the national school programme will become eligible for CervicalCheck. These women are at a lower risk of developing cervical cancer.
Dr Ryan said the current vaccine did not protect against all virus types that can lead to cervical cancer so vaccinated women should be screened every five years.
The change to HPV testing will save up to €3m for women who have received the HPV vaccine, €32m for the unvaccinated group, and up to €35m for the entire CervicalCheck population over an eight-year period from 2018.
Clinical director of CervicalCheck, Dr Grainne Flannery, said discussions on changing cervical screening technology would take place between the Department of Health, the HSE, and National Screening Service over the coming months.
Dr Flannery said cervical screening uptake rates had been strong with 79.7% of women aged 25 to 60 screened over the last five years.
To date over 50,000 had been treated for pre-cancerous abnormalities and over 1,200 cancers detected.
Head of research at the Irish Cancer Society, Dr Robert O’Connor, who was a member of the expert advisory group for the assessment of HPV testing, said an estimated 90 women would die from cervical cancer in Ireland this year. He called on the Minister of Health to heed Hiqa’s advice — it was in the best interests of all women in Ireland.
