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The workfield of cervical cancer screening is in full development. Due to tremendous efforts of researchers and researchgroups worldwide, we have already been able to achieve a lot in the field of innovation. In recent years, more evidence for new screening technologies has become available from scientific research. In order to achieve the objective of the WHO, it is important that research is implemented into cervical cancer screening programs. However, this implementation is not self-evident and can sometimes take quite a long time. By means of a discussion between researchers and clinicians, we want to provide more insight into this transition from research to implementation on the basis of 3 potential new screening technologies on the roadmap to eliminate cervical cancer: HPV-screening, self-sampling and methylation.
An overview of the development of cervical cancer screening over the years, focusing on the achievements until now, in terms of absolute health gains and in terms of reduction and increase in inequities. And how further improvement can be reached by the introduction of (potential new) screening technologies.
Research has shown that primary HPV screening can increase the sensitivity of screening programs. In addition HPV-testing may be accessible to more countries, as it is cheaper and easier to perform. And it’s opening up opportunities for self-sampling and HPV-vaccinated cohorts. So, it’s time to implement primary HPV screening everywhere to eliminate cervical cancer.
The time may be right scientifically, but then there are several practical obstacles that make it impossible to move quickly in certain countries. The Slovenian organized programme is coping with some unique challenges. Certain conditions must be met when implementing primary HPV screening.
A discussion will be held with the participants of the workshop focusing on the conditions under which countries could successfully implement HPV-based screening.
Research in recent years gives strong indications that self-sampling can reach a significant part of the non-responder population of cervical cancer screening programs. Experiences from Sweden, especially since COVID19-times have shown great opportunities for self-sampling. Self-sampling is easy and reliable. Therefore, the time is right for the primary use of self-sampling in screening programs.
We need to move carefully on self-sampling, particularly in countries that have been operating a very efficient and quality-assured screening service for a long time. The early-adopter evidence is eye-opening in this respect. We will discuss the necessary mitigations, impact of lab-processes and what kind of research work needs to be prioritized. Not for every country, the time is right to introduce self-sampling.
A discussion will be held with the participants of the workshop focusing on the conditions under which countries could successfully implement self-sampling.
Research in the field of biomarkers indicates that methylation as a triage method could increase the specificity of primary HPV screening programs. Introduction of primary HPV screening in several countries has shown that the sensitivity of the program increases, but at the same time the specificity decreases resulting in a higher proportion of unnecessary referrals. So, methylation shows enormous opportunities and the time is right to introduce methylation in the management of HPV positive women.
To implement a new technique into organized screening programs, we need more than just research. For instance within the domains of equity, feasibility, acceptability, (balance of) desirable and undesirable effects, validation, CE-approval, high-throughput machines, trained professionals and cost-effectiveness. We cannot implement methylation in screening (yet).
A discussion will be held with the participants of the workshop focusing on the conditions under which countries could successfully implement methylation.