Prof Ian Frazer
Date: 
July 10, 2018

We can eliminate cervical cancer within a generation - Irish Cancer Society

Move to primary HPV testing, with co-ordinated information campaign and increased resources, urgently required

Ireland's health system must urgently move to a new primary form of cervical screening which, together with vaccination, has the potential to eliminate cervical cancer in Irish women within a generation, the Irish Cancer Society has said.

The call was made at a special information event hosted by the Society and the Royal College of Physicians of Ireland which heard how the introduction of HPV testing as the country's primary cervical screening method would:

  • lead to 20% more precancerous abnormalities being detected
  • result in 30% more cervical cancer cases and deaths being avoided for every screening test carried out, compared to the current screening strategy
  • reduce the interval required between screenings, from the current three to five years for most women.*

However, at the event experts stressed that speed in the implementation of HPV testing should not be at the price of quality. A move to primary HPV testing must be accompanied by a targeted information campaign to clinicians and the general public on the benefits and limitations of screening, as well as adequate resources in the healthcare system to deal with increased demand for treatments resulting from more precancerous abnormalities being detected.

Speaking at today's event, Dr Robert O'Connor, Head of Research at the Irish Cancer Society, said:

“This year in Ireland around 90 women will die from cervical cancer. A further 280 will be diagnosed with this serious illness, with unfortunately four-in-ten of them dying within five years.

“Cervical screening works by detecting abnormalities that can be treated before they potentially develop into cancer. Each year around 6,500 Irish women need hospital treatment to remove precancerous growths in their cervix.

“By moving to primary HPV testing, we’ll be able to find more of these growths and act sooner to treat them, saving more women’s lives in the process.”

The liquid cytology ‘smear’ test currently used primarily is only able to reliably detect the most common form of cervical pre-cancer - those that give rise to squamous cancers.

It is expected that a change to screening based on HPV testing in the first instance will improve the detection of precancers, including some of those which the current smear does not pick up.

In May 2017, HIQA recommended that HPV testing be introduced as the primary cervical screening method, with the smear test still being used, but only in certain cases where a follow-up screening is required.

Speaking at today’s event, Chair-Elect of the RCPI’s Institute of Obstetricians and Gynaecologists Dr Cliona Murphy said: “It’s important to note that screening does not, and never will, diagnose cancer. It exists to pick up changes which may lead to cancer, allowing doctors to treat the patient quickly and effectively before a cancer potentially arises.

“Primary HPV testing won’t be perfect. Like the current smear test, not all abnormalities will be spotted before they become cancerous. But international studies show that HPV testing can find more precancers and increase detection to about four-in-five cervical abnormalities, compared to three-in-five that are found through the current smear test system.”

Dr O’Connor added: “Should primary HPV testing become a reality in Ireland, it by no means would replace HPV vaccination. Screening can detect cancerous and pre-cancerous cells, but treatment to remove these cells can be harsh and invasive. What’s more, detection through screening is no guarantee of survival. Vaccination, on the other hand, can stop these cancerous cells from developing in the first place. The vaccine is safe and proven to save lives, and the more people who are vaccinated, the more effective it will be for the population at large.

“The women of Ireland deserve the best possible services when it comes to the safe prevention and early detection of cancer. A move towards primary HPV testing gives them this. We call on the Minister for Health to heed HIQA’s advice and move CervicalCheck to this form of testing, while ensuring medical professionals and the general public have the information and resources available to ensure women in Ireland receive the best care possible.”