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

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.

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Acknowledgements

European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC).

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M.K. edited and contributed to the content of all chapters. The paper was conceived by M.G. and J.C. More specifically: Cytology (P.S., C.B.); HPV test (K.C., M.P., C.B.); Quality assurance (J.D., V.K., M.A.); cost-effectiveness (M.J., J.K.); screening in vaccinated (X.B., P.S.). All authors have contributed to the writing of the manuscript and have approved the final version.

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Correspondence to Maria Kyrgiou.

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F.X.B. has received institutional research and educational support from Hologic and MSD and personal support from MSD, Hologic and Seegen for traveling and speaking at medical symposiums; M.G. has received personal support from MSD for traveling and speaking at medical symposiums; M.K. has received institutional research and educational support from MSD and personal support from MSD and Hologic for traveling and speaking at medical symposiums. The rest report no conflict of interest. MA’s institution received funding from the European Society of Gynaecological Oncology, the European Federation for Colposcopy and the Horizon 2020 Framework Programme for Research and Innovation of the European Commission, through the RISCC Network (grant no. 847845). J.C. is an editorial board member of the BJC.

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Kyrgiou, M., Arbyn, M., Bergeron, C. et al. Cervical screening: ESGO-EFC position paper of the European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC). Br J Cancer 123, 510–517 (2020). https://doi.org/10.1038/s41416-020-0920-9

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