Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing

Abstract

Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.

Keywords: HPV test; HPV vaccination; cervical cancer; cervical cytology; human papillomavirus.

Figure 1

Management algorithm in primary HPV screening. Abnormal cytology refers to a borderline or more severe cytological result. This algorithm was developed based on “The supplements of the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening of 2015” [55].

Figure 2

The implementation status of HPV vaccination in E.U. member states and some E.U. associated countries as of 15 May 2018, based on the World Health Organization (WHO) “Vaccine in National Immunization Program Update”. Source: http://www.who.int/immunization/monitoring_surveillance/data/en/; assessed for the last time on 16 July 2018 [131]. The magnifying glass serves to enlarge the island of Malta.

Figure 3

The implementation status of primary HPV testing in E.U. member states and some E.U. associated countries. The magnifying glass serves to enlarge the island of Malta. It is important to state that this is a rapidly changing field and that the status of implementation could not be confirmed for all countries from two independent sources.

Figure 4

Health care providers that act as sample takers in cervical cancer screening programs in E.U. member states and some E.U. associated countries. The magnifying glass serves to enlarge the island of Malta. It is important to state that this is a rapidly changing field and that the status of implementation could not be confirmed from two independent sources and that this is a rapidly changing field. This figure was designed based on information available in Table 1 and Basu et al., 2017 [115].