Human Papilloma Virus (HPV) testing is currently implemented in a randomized controlled fashion as the primary test in the Norwegian cervical screening programme. Women are allocated randomly to either HPV test or liquid-based cytology based on their date of birth. The implementation involves women in the age group 34-69 years in four Norwegian counties, counting approximately 285 000 women. The impact of the new screening strategy on the attendance rate of the women receiving an invitation letter was evaluated.
Systematic information and appropriate organization may be important for the acceptance of new screening strategies, both for health professionals and target women. The Cancer Registry of Norway was responsible for the coordination of the preparations prior to implementation, and two expert groups were established to support the effort. The first group focused on: 1) information to involved parties (the women, the GPs, the gynecologists and the laboratory staff), 2) establishing laboratory infrastructure and procedures, and 3) changes in data flow and invitation/reminder routines at the Norwegian Cancer Registry. The second group concentrated on 1) the scientific safeguard and 2) the development of project evaluation protocols.
One year after project initiation, the logistical implementation of the project is evaluated to be successful. Careful preparation has translated to a smooth transition from cytology to HPV testing with only minor exceptions reported. The IT-solutions for randomization are established in each laboratory, and is under continuous optimization to secure optimal and equal follow-up for every woman. The test results are reported by the laboratories to the Norwegian Cancer Registry, and analysed quarterly. Information has been provided to the women through newspapers, social media, information letters and leaflets. The implementation of a new screening test has achieved general acceptance, and the screening attendance after invitation letters has been comparable between the women offered HPV test and the women getting a cytological evaluation of their samples, 44.8%±0.9 vs 44.0%±0.8, respectively.
It is important to prepare a national implementation of HPV based screening in close collaboration with all stakeholders in order to prevent misunderstandings and ensure high quality and optimal security for the individual women at all stages. After thorough preparations and dissemination of information, the implementation of HPV testing did not produce any changes in screening acceptance in Norway.