15 Aug 2022

HIQA advises a change to HPV testing as the primary cervical screening method

HIQA advises a change to HPV testing as the primary cervical screening method

HIQA has advised that CervicalCheck – Ireland’s National Cervical Screening Programme changes its primary screening method to HPV testing.

The Health Information and Quality Authority (HIQA) has advised that CervicalCheck – Ireland’s National Cervical Screening Programme changes its primary screening method to HPV testing.

HIQA carried out a health technology assessment (HTA) to assess the impact of changing from the current policy of primary screening with liquid-based cytology to primary screening with HPV testing.

Today’s Health technology assessment (HTA) of human papillomavirus (HPV) testing as the primary screening method for prevention of cervical cancer found that changing to primary HPV testing would reduce the number of screenings each woman has in her lifetime, while providing better accuracy in detecting precancerous abnormalities and early stage invasive cervical cancer.

It is important to note: Women would experience no change in how the cervical screening sample is collected.

HIQA’s Director of Health Technology Assessment and Deputy Chief Executive Dr Máirín Ryan said, “HPV infection is associated with almost all cervical precancerous abnormalities and invasive cervical cancers. Compared with the current screening strategy, primary HPV screening is a better test which allows all women who participate in cervical screening to become aware of their current HPV status and those who are at higher risk of cervical cancer to be picked up earlier.”

“Where a woman is found to be HPV-positive following primary HPV screening, a follow-up test using liquid-based cytology will be carried out on that same sample to inspect for cellular abnormalities. If any abnormalities are detected, a more detailed examination of the cervix (colposcopy) is needed. Women with a negative HPV test can be reassured that they are at very low risk of developing precancerous abnormalities in the next five years. For this reason, we advise that the interval between screenings can be increased to every five years for those currently being screened three-yearly. A change to primary HPV screening means the same benefit is provided to women in fewer screenings.”

Implementing primary HPV screening five-yearly from age 25 to age 60 would lead to two fewer screening tests over a woman’s lifetime. 20% more precancerous abnormalities would be detected and 30% more cervical cancer cases and deaths would be avoided for every screening test carried out compared with the current screening strategy.

“As HPV infection is more common in younger women, women who have not been vaccinated against HPV and who are aged between 25 and 30 years may benefit from three-yearly screening to ensure they are protected.”

Dr Ryan continued, “CervicalCheck began in 2008 and there has been good uptake with four in five eligible women up to date with their smear tests. However, this decreases with age. For this reason, HIQA advises that cervical screening may be extended up to 65 years of age for women who have only had the benefit of routine cervical screening from age 50. While this would come with an increased cost, it would provide additional clinical benefit for these women.”

In 2018, the first women vaccinated against HPV 16 and HPV 18 as part of the national school-based immunisation programme will become eligible for CervicalCheck. These women are at lower risk of developing cervical cancer.

However, as the current vaccine does not protect against all virus types that can lead to cervical cancer, vaccinated women should still attend for regular cervical screening.

Dr Ryan said: “Vaccinated women should be screened every five years with HPV testing, as it is the best strategy in this group.

This report was approved by the Board of HIQA and will now be submitted to CervicalCheck - Ireland’s National Cervical Screening Programme and the Minister for Health to inform decision-making about the screening programme.

Read the full HTA at

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