At present in England, cervical screening is recommended every three years for women 25-49 years of age and every five years for women 50-64 years of age. The recommended screening test is liquid-based cytology. Human Papillomavirus (HPV) testing is used for triage of low grade cellular abnormalities and as test of cure after treatment of cervical intraepithelial neoplasia. For now, screening recommendations for vaccinated birth cohorts remain the same as for unvaccinated birth cohorts.
HPV testing is going to replace cytology in primary screening in spring 2019, with reflex cytology being used for triage. An HPV primary screening implementation group consisting of various stakeholders and experts has been established by Public Health England (PHE) to develop plans to roll out this service by the agreed deadline. At present, 59 laboratories provide cytology services to the programme; with HPV testing, it has been decided that the number of screening laboratories will be substantially lower although the decision on the exact configuration is still pending upon an on-going options appraisal. Much attention is given to sample taker training, and guidance is being provided to laboratories in terms of choosing HPV assays.
To support the decision-making, six sites started a pilot implementation of HPV-based primary screening in mid-2013, which is running in parallel with the routine cytology-based screening. These data will help establish the demand for e.g. colposcopy services in a routine setting, and inform the decisions on the screening interval and the clinical follow-up after a positive HPV test result. Furthermore, this pilot will establish the economic cost of the switch from cytology to HPV testing, as well as provide information on its psychological consequences for the women.
The screening programme is at present facing a number of challenges. One is a call-recall system which was established in the late 1980’s. It is currently undergoing a thorough overhaul so that it will be robust enough to support the new HPV-based programme once rolled out. Another challenge is a falling coverage that has been observed in all age groups, with one in every five local authorities reaching less than 70% of the targeted women. This can hopefully be addressed through HPV-based self-sampling, which is one of the current research priorities.
PHE’s screening blog is regularly updated with news regarding HPV-based primary screening: https://phescreening.blog.gov.uk/.