Cervical Cancer Screening and Human Papillomavirus (HPV ... - KCE

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KCE reports vol.38C Title : Cervical Cancer Screening and Human Papillomavirus (HPV) Testing. Authors : Frank Hulstaert, Marc Arbyn (IPH), Michel Huybrechts, Imgard Vinck, Marina Puddu (IPH), Dirk Ramaekers External experts: John-Paul Bogers (Pathology, Antwerp), Frank Buntinx (General Practice, Leuven), Philippe Delvenne (Pathology, Liège), Ria Drijkoningen (Pathology, Leuven), Patricia Eeckeleers (General Practice, SSMG), Wilfried Gyselaers (Gynaecology, Genk and Maastricht), Geert Page (Gynaecology, VVOG), Willy Poppe (Gynaecology, Leuven), Frank Smeets (General Practice, Domus Medica), Erik Van Limbergen (Center for Prevention of Cancer, Leuven), Marc Van Ranst (Virology, Leuven), Steven Weyers (Gynaecology, Gent) External validators : Foidart Jean-Michel (Gynaecology, Liège), Vandenbroucke Ann, Cliniques Universitaires Saint-Luc, Van Ballegooijen Marjolein, Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands Conflict of interest : John-Paul Bogers declares having a part-time activity as a pathologist at a private clinical laboratory performing HPV-tests. Marc Arbyn declares to have received travel grants from MSD Sanofi-Pasteur and GSK, and to be a member of an advisory board at GSK. Disclaimer: The experts and validators collaborated on the scientific report, but are not responsible for the policy recommendations. These recommendations are under the full responsibility of the Belgian Health Care Knowledge Centre. Layout : Dimitri Bogaerts Brussels, December 2006 (2 nd print; 1 st print, September 2006) Study nr 2005-13 Domain : Health Technology Assessment (HTA) MeSH : Cervix Neoplasms ; Papillomavirus, Human ; Mass Screening ; Vaginal Smears NLM classification : WP 480 Language: English Format : Adobe® PDF (A4) Legal depot : D/2006/10.273/37 Any partial reproduction of this document is allowed if the source is indicated. This document is available on the website of the Belgian Health Care Knowledge Centre (KCE). How to refer to this document? Hulstaert F, Arbyn M, Huybrechts M, Vinck I, Puddu M, Ramaekers D. Cervical Cancer Screening and Human Papillomavirus (HPV) Testing. Health Technology Assessment (HTA). Brussels: Belgian Health Care Knowledge Centre (KCE); 2006. KCE reports 38C (D/2006/10.273/37)
KCE reports vol.38C - Cervical Cancer Screening and HPV i Foreword Cervical cancer is unique because it only occurs in women infected with specific types of the Human Papillomavirus (HPV). In most women such infection will clear spontaneously. In rare cases malignant changes will develop. These changes can be detected at an early stage using a conventional Pap smear and timely removed. Many women rely on a yearly cervical smear taken for prevention of cervical cancer. What do the scientific studies and the guidelines of gynaecologists and general practitioners tell us about the usefulness of this annual test? A few years ago a new player entered the market: detection of HPV using a molecular test. From the many contacts we had with experts during the course of this study, we learned that some laboratories systematically perform an HPV test for every cervical smear. As this test is currently not reimbursed by the health insurance, many women are simply billed for this test, for a variable amount. In this report the reader can find the evidence supporting the use of the HPV test and whether it can replace the conventional smear. This report also discusses the possible psychological harm for women and their partners of systematic screening using HPV tests. What to do if the HPV test is positive and the smear does not show any abnormalities? Should women be informed beforehand of the significance of a positive HPV test? Another observation was the large variability in Belgium for the use of colposcopy, the visual inspection of the uterine cervix. Is there any evidence supporting such practice for screening? Finally, over 40% of Belgian women between 25 and 64 are never or only rarely screened for cervical cancer. Increasing the uptake of cervical cancer screening in this population remains a challenge for the preventive healthcare. A well-organised setting is required to succeed, as was demonstrated in several European countries. So far, this step was not taken in Belgium. From a policy making point of view there is thus room for improvement. This HTA report aims to assist the decision makers in the organisation of a high quality and easily accessible screening for cervical cancer. It also makes suggestions for a more efficient use of the available budget. Our appreciation goes to the many gynaecologists, general practitioners, pathologists and experts of the communities for their highly valued scientific input. We extend our appreciation to the specialist scientific organisations BSCC (Belgian cytology labs) and VVOG (Flemish gynaecologists) for the organisation of a survey among their members. This up to date information proved to be of very useful during the interesting discussions on cervical cancer screening in the context of this HTA. Jean-Pierre CLOSON Dirk RAMAEKERS Adjunct Algemeen Directeur Algemeen Directeur
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Cervical Cancer Screening and Human Papillomavirus (HPV ... - KCE

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