Oct 15, 2014
In Spain, a new era in Cervical Cancer Screening has now begun: For the first time the country’s guidelines for cervical cancer screening recommend testing for human papillomavirus (HPV) as a first-line screening method. It took more than two years to update the guidelines and eight scientific societies were involved in the review of the revised cervical cancer screening protocol. In October 2014, the new guidelines were published in two highly respected scientific journals: those of the Spanish Society of Gynecology (SEGO) and of the Spanish Society of Pathology (SEAP).
Cytology-based screening methods like the Pap cytology test have played an essential part in diagnosing cervical diseases, not only in Spain but also globally. However, cytology screening has limited sensitivity and can fail to detect approximately 50 percent of pre-cancerous cervical lesions. As HPV infections cause more than 99 percent of all cervical cancers, HPV testing is a highly sensitive and effective screening method. It discovers whether the virus is present and helps determine a woman’s specific risk of cervical cancer depending on the presence of high-risk (hr) genotypes such as hrHPV 16 or hrHPV 18. Thus, HPV screening provides physicians with certainty about their patients’ risk status, enabling them to act quickly to prevent the disease. In order to more effectively combat cervical cancer, many experts therefore recommend implementing HPV testing in addition to or instead of Pap cytology testing.
HPV testing recommended as primary screening
The new Spanish cervical cancer screening guidelines were prepared by a panel of experts and key opinion leaders from the areas of Gynecology, Gynecological Oncology, Pathology and Cytology. Led by Dr. Aureli Torné and Dr. Javier Cortés, the group took into account the latest scientific evidence and developments in this field. While the new guidelines still accept cytology testing as a screening method, they strongly recommend moving from Pap to HPV testing in the next 3-5 years. For the first time, HPV testing is considered to be the preferred method for primary screening in women from the age of 30 years onwards. In case of a negative test result, the guidelines recommend a repeat testing within a period of five years. If the test result is positive, genotyping for hrHPV 16/18 and a triage test based on the detection of the cellular biomarker p16 are recommended, e.g. Roche’s CINtec Plus Cytology test or Roche’s CINtec Histology assay. These tests help to identify women in need of immediate disease management and increase the diagnostic accuracy for detecting high-grade disease. The revised screening protocol was jointly established by eight Scientific Societies from highly relevant areas, including Gynecology, Pathology, Cytology, Epidemiology, Family Medicine and Primary Care.
Unanimous acceptance of new screening guide
This broad acceptance is an important success factor when it comes to implementing the new procedures in the screening routine. “Recommendations for a change in clinical procedures must necessarily be based on two points: unanimity of the scientific community in its formulation, and first-level evidence that supports it. The new Guide for Cervical Cancer Screening in Spain 2014 meets both requirements. Endorsed by eight Spanish Scientific Societies, their decision-making algorithms are based on high-quality evidence,” says Javier Cortés, co-author of the Guide, on behalf of the Spanish Society of Gynecology. “Detecting Human Papillomavirus DNA with a single screening test – for the right age group – is more efficient and effective than the cytology-based strategy. There is no doubt about it, and this is the line that major international cooperative groups are following.”