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HPV test added to cervical cancer screening



By Lilian Anekwe

The Government is predicting ‘major cost savings’ through the NHS cervical cancer screening programme after announcing GPs in England will begin use of HPV testing from April.

NHS advisers are predicting it will substantially reduce the number of young women requiring repeat screening after detection of borderline abnormalities – although it could also slow down results.

The NHS cervical cancer screening programme in England will work with PCTs and GP commissioners to roll out HPV testing for triage of women with borderline or low-grade cervical abnormalities to all hospital laboratories from April this year. Scotland uses HPV testing just for treatment follow-up, while Northern Ireland and Wales are running studies.

Last year, 3.6 million women in England were screened for cervical cancer and 240,000 found to have borderline or low-grade abnormalities.

All would currently be screened annually to monitor for cervical cell changes, which is costly and causes anxiety. Under the new system, women who test negative for HPV will continue to be screened, but only once every three years in women under 50 and every five years in women aged 50 to 64.

Only women who test HPV positive will be referred either for more regular screening for women with borderline abnormalities, or colposcopy in women with low-grade lesions.

Details of how HPV testing will be rolled out are set to be published in March. It is likely HPV testing will be rolled out area by area, beginning in April.

Only two hospital laboratories – in Bristol and Manchester – currently use HPV testing to analyse cervical screens, but the NHS Cancer Screening Programmes confirmed all had the capacity to analyse samples.

The spokesperson added: ‘The impact on GP practice is likely to be minimal, but it will have a significant impact on the patient pathway.’ At one sentinel site in north-west London, HPV testing reduced the number of women requiring consecutive post-treatment cytological surveillance by more than 85%.

The Department of Health said HPV testing would lead to ‘a more patient-centred service and major cost savings’.

Professor Henry Kitchener, head of gynaecological oncology at the University of Manchester and chair of the DH’s advisory committee on cervical cancer, said: ‘It will allow us to distil women with low-grade abnormalities into those at virtually no risk and those at risk.’

Dr Jane Woyka, a GP in Harrow, Middlesex, and a committee member said: ‘HPV testing can be done using the same liquid-based cytology sample. One concern is it will increase the turnaround time for a screen.’

HPV testing will reduce the number of women needing cervical smears HPV triage guide Download a HPV triage guide

Download a flowchart for HPV triage and test of cure protocol here.