Primary HPV test - now also for women under 34
The change entails switching from screening method cytology test every three years, to HPV testing every five years for women aged 25-33 years.
For women aged 34 years and older, the cervical sample has been checked for HPV instead of looking at the cells under the microscope. Women in the age group 25 - 33 years have so far had the cells from the cervical sample studied under a microscope.
HPV stands for human papillomavirus and HPV is an important factor for the development of the vast majority of cases of cervical cancer.
The HPV test is safer than cytology, and will find more people who have cervical dysplasia.
HPV screening has the potential to prevent even more cervical cancers and reduce mortality from the disease, compared to cytology.
Introduction of HPV test for younger women
The steering committee for the screening programmes decided, in November 2022, that HPV testing should be the primary screening test for all women aged 25 to 69 who participate in the CervicalScreen Norway.
The introduction is now, after July 1th, 2023, done for all women between the ages of 25-69. The change to the screening test for the younger women (25-33 years) was made gradually, from January 1th to July 1th, 2023, to ensure that laboratories had enough time to readjust their IT-systems.
The cervical program includes women aged 25-69 years, and currently recommends HPV testing every five years. Every year, around 400,000 women participate in the CervicalScreen Norway. [1].
In 2022, Norway had a cervical cancer incidence with an age-adjusted incidence rate of 8.4 per 100,000 person-years by default. This equates to 302 women diagnosed with cervical cancer in 2022 [1].
Evaluation of the pros and cons
The biggest benefit of introducing the intervention is that HPV screening of the youngest women in the age group 25 to 33 years could roughly reduce the number of cancer cases by up to 44 cases each year, while being cost-effective.
The disadvantages of HPV testing for the youngest women are that an HPV-positive response can and will be perceived by some as stressful. Very few people who have a positive HPV test will develop cancer. Treatment of severe cervical dysplasia may slightly increase the risk of premature births.
Overtreatment will occur in a screening programme, as we currently do not know which serious cell changes would have gone into spontaneous regress without treatment.
To reduce this disadvantage of HPV screening, a better adapted follow-up pathway, with the use of, for example, extended genotyping, could reduce the number of colposcopy referrals and thereby reduce overtreatments.
Therefore, women, where the test is HPV positive but negative for HPV16/HPV18 and cytology is normal, a new test is recommended in three years (instead of after 2 years). This is justified by the fact that the risk of developing cancer is very low in this group.
The working group that prepared the proposal considered that an improved cancer prevention effect outweighs the disadvantages of introducing HPV screening to younger women.
(Link to the report and relevant literature in the side menu)
References:
- Cancer Registry of Norway. Cancer in Norway 2022 - Cancer incidence, mortality, survival and prevalence in Norway. Oslo: Cancer Registry of Norway, 2023.
- Mitchell H, Medley G, Gordon I, et al. Cervical cytology reported as negative and risk of adenocarcinoma of the cervix: no strong evidence of benefit. Br J Cancer 1995;71:894–7.
- Andrae B, Kemetli L, Sparen P, et al. Screeningpreventable cervical cancer risks: evidence from a nationwide audit in Sweden. J Natl Cancer Inst 2008; 100:622–9
- Lønnberg S, Anttila A, Luostarinen T, et al. Agespecific effectiveness of the Finnish cervical cancer screening programme. Cancer Epidemiol Biomarkers Prev 2012; 21:1354–61
