Screening with HPV testing can reduce by 60%-70% the incidence of invasive cervical cancer than screening with Pap test1. The protocol for HPV-DNA-based primary screening for cervical cancer was suggested by a Health Technology Assessment Report2 in 2012. The new algorithm requires a structured investment/disinvestment process. In Italy, a research project has been carried out with the main objective of developing a shared methodological approach to address the introduction of routine HPV-DNA testing for primary screening.
A survey was carried out, through a questionnaire sent to managers of all Italian regional screening programs, in order to collect information about strategies for implementation of HPV-DNA-based primary screening. It was also performed a systematic review of the literature concerning recommendations, guidelines, HTA reports, indicators, criteria of centralization, disinvestment plans. Data were analyzed by a Working Group composed of Italian screening experts. Criticalities were discussed and consensus was found on suggestions for screening managers involved in implementation.
Nine regional programs answered to the questionnaire. Most of respondent screening programs chose to plan a transitional phase of several years to allow the adjustment of the volume of activity in the transition from the three-year screening interval to the five-years one. All respondent Regions planned the centralization of execution of molecular tests, as well as training of professionals and information to women. According to the cost analysis performed by the Working Group, HPV-DNA-based screening allows to save resources if a reduction of personnel is feasible. In 2012, in Italy, 131,155 women were screened with HPV test3. As an example, in the Piedmont Region, in 2014, 25,289 DNA-HPV tests were performed, out of 185,144 tests4.
According to the results of this project, it appears to be very important to regulate activity volumes in the transition, by modulating the flow of access to the new test. This entiles the co-existence of two screening pathways for a period and a fair and objective selection method for women. Another key point is the centralization of executions of molecular tests, that showed to lead also to cytology centralization. Centralization and efficiency strategies must include human resources reorganization, that may represent a tricky issue but showed to be less difficult in contexts with shortcoming of personnel.
1. Ronco G, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet 2014; 383: 524-32
2. Ronco G, et al. Health Technology Assessment Report: HPV-DNA-based primary screening for cervical cancer precursors. Epidemiol Prev 2012; 36 (3-4) suppl 1: e1-72
3. Zappa M, et al. The national Centre for Screening Monitoring. Eleventh Report. Epidemiol Prev 2015; 39(3) Suppl 1: 1-125
4. AAVV. [“Prevenzione Serena”. Results, research, quality. Results 2013 – Preliminary data 2014]. Centre for Cancer Epidemiology and Prevention in the Piedmont Region. Turin, 2015. Italian