More sensitive cervical swab to younger women
"Over time, we have seen an increase in the incidence of cervical cancer. Although assessing a cell sample under a microscope has been a great method, the HPV test en more sensitive method. Women with confirmed HPV are further assessed. In this way, the risk of overlooking severe cell changes will be even lower," says Tropé.
Director of the Cancer Registry of Norway, Giske Ursin, is also pleased with the decision:
"This is precisely the change we have hoped would come. When more and more younger women are vaccinated against HPV, and we gradually introduce the offer of home tests, this gives us good opportunities to reach WHO's goal that cervical cancer can be virtually eradicated, she says.
From Pap smear to HPV test
For women aged 34 and over, the cervical sample has gradually been checked for HPV instead of looking at the cells under the microscope since 2015.
The HPV test can more easily identify who is at increased risk of cervical dysplasia, and thus prevent cervical cancer better. Since the test is more sensitive, you only need to get tested every 5 years.
Tropé explains why it was initially decided to only introduce HPV testing to women between the ages of 34 and 69:
"It is very common for young people to have an ongoing HPV infection, which often goes away on its own. If we detect an HPV infection, this can lead to unnecessary concern for young women, and to overinvestigation and overtreatment. Therefore, there has been professional scepticism about offering HPV testing to everyone.
But in recent years , there has been an increasing incidence of cervical cancer among the unvaccinated portion of the population in Norway.
"This may be because there have been too few people who have had a cervical swab for a long time when they are reminded. Among the unvaccinated, there has also been a sharp increase in HPV infection, says Tropé.
HPV test useful for preventing cervical cancer
In 2021, there were 345 women who were diagnosed with cervical cancer, and of these, 64 were under the age of 35.
There are essentially two types of cervical cancer. One is usually discovered under the microscope when looking at the cells. The other may be located so in the cervix that the diseased cells are more difficult to obtain on a pap smear, and these cells are also more difficult to interpret under the microscope. The latter has seen an increase of, and here the HPV test will be particularly useful.
"HPV testing of young women can help us prevent this type of cervical cancer to an even greater extent," says Tropé.
The steering group for the national screening programmes is chaired by the Norwegian Directorate of Health, and it has now decided to introduce HPV testing to women between 30-33 years from 1 January 2023 and from 25-29 years from 1 July 2023.
Tropé explains why the new scheme is not being introduced for everyone at the same time;
"The reason is that hospitals should be able to change their IT systems. The youngest women need a different follow-up plan to avoid overassessment. It is quite an extensive work to bring about this change in the IT systems.
Up to 44 fewer cancer cases each year
A working group appointed by the Norwegian Directorate of Health, with experts from several disciplines in cervical cancer screening, has assessed the advantages and disadvantages of introducing HPV screening for all women in the programme, including the youngest.
The working group has assessed that an improved cancer prevention effect outweighs the disadvantages of introducing HPV screening to younger women.
"The biggest benefit is that HPV testing of the youngest women in the age group 25 to 33 years can roughly reduce the number of cancer cases by up to 44 per year," says Tropé.
However, she emphasizes that such testing also has disadvantages, and that some women experience an HPV-positive response as stressful.
Fortunately, very few people who have a positive HPV test will develop cancer, and HPV infection does not necessarily mean that you have or will have cell changes that need treatment.
Nevertheless, the risk of overtreatment is among the biggest concerns when all women are now tested with the more sensitive test.
"The treatment for severe cervical dysplasia increases the risk of bleeding and premature birth, and we naturally want to avoid this as much as possible for women where the changes would otherwise have gone back on their own," says Tropé.
The working group that prepared the proposal has therefore also proposed how to reduce the risk of over-examination and treatment.
Women who are HPV-vaccinated must also get screened
The HPV vaccine works very well. In 2022, those who were vaccinated for the first time in the Childhood Immunisation Programme will turn 25. These women are advised to check themselves if they have received the vaccine.
"This is because there are more HPV types than those you are vaccinated against, which can cause cancer. Therefore, these women must also attend screening regularly.