Cervical screening: ESGO-EFC position paper of the European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC)

Br J Cancer. 2020 Aug;123(4):510-517. doi: 10.1038/s41416-020-0920-9. Epub 2020 Jun 8.

Abstract

This paper summarises the position of ESGO and EFC on cervical screening based on existing guidelines and opinions of a team of lead experts. HPV test is replacing cytology as this offers greater protection against cervical cancer and allows longer screening intervals. Only a dozen of HPV tests are considered as clinically validated for screening. The lower specificity of HPV test dictates the use of triage tests that can select women for colposcopy. Reflex cytology is currently the only well validated triage test; HPV genotyping and p16 immunostaining may be used in the future, although methylation assays and viral load also look promising. A summary of quality assurance benchmarks is provided, and the importance to audit the screening histories of women who developed cancer is noted as a key objective. HPV-based screening is more cost-effective than cytology or cotesting. HPV-based screening should continue in the post-vaccination era. Only a fraction of the female population is vaccinated, and this varies across countries. A major challenge will be to personalise screening frequency according to vaccination status. Still the most important factor for successful prevention by screening is high population coverage and organised screening. Screening with self-sampling to reach under-screened women is promising.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cervix Uteri / virology*
  • Consensus
  • Cyclin-Dependent Kinase Inhibitor p16 / metabolism
  • Early Detection of Cancer
  • Female
  • Genotyping Techniques
  • Humans
  • Papillomaviridae / genetics
  • Papillomaviridae / isolation & purification*
  • Papillomavirus Infections / diagnosis*
  • Papillomavirus Infections / metabolism
  • Papillomavirus Vaccines / therapeutic use
  • Practice Guidelines as Topic
  • Pregnancy
  • Sensitivity and Specificity
  • Uterine Cervical Neoplasms / virology*
  • Vaccination / statistics & numerical data
  • Viral Load

Substances

  • CDKN2A protein, human
  • Cyclin-Dependent Kinase Inhibitor p16
  • Papillomavirus Vaccines