Guidelines released to boost cervical cancer screening in high-income countries

Guidelines released to boost cervical cancer screening in high-income countries | Image Credit: © Chinnapong - © Chinnapong - stock.adobe.com.

The Advancing Cervical CancEr ScreeningS (ACCESS) Consensus Group has released guidelines for cervical cancer screening in high-income countries in an attempt to reduce mortalities from this highly preventable disease.¹

Cervical cancer remains a significant health concern in high-income countries, with a high prevalence of cervical cancer mortality reported in 2022. This included 238 women in Sweden, 1530 in France, and 5932 in the United States. These cases often occur in women with irregular or no screening.

While the human papillomavirus (HPV) vaccine effectively protects patients from cervical cancer, population-wide protection cannot be provided for decades. Cervical cancer screening programs are available in many high-income countries to reduce incidence and mortality, but participation rates remain as low as 25% in some countries.

Health outcomes have been significantly impacted by low participation, with women who do not receive regular screening at increased risks of cervical cancer incidence, advanced disease, and poorer outcomes. Therefore, individual and societal benefits may be obtained through empowering women to receive screening.

For decades, many high-income countries have had screening programs for cervical cancer. Data has indicated a 92% reduced risk of cervical cancer mortality among women with regular screening, as treatment of precarious lesions has high efficacy.

“For high-income countries with organized screening and vaccination programs, cervical cancer elimination is a realistic possibility in the coming years,”¹ the guidelines state, citing screening as the most effective intervention for reducing short-term cervical cancer burden.

Cervical cancer risk is greatest among women in the most disadvantaged communities. Lower rates of screening participation are partly responsible for this disparity, making action to address low screening rates among underscreened groups vital.

ACCESS recommends national actions plans to eliminate cervical cancer be developed. These plans should be based on framework from the World Health Organization (WHO) but go beyond WHO targets while aligning with broader health care and women’s health strategies.

WHO targets include HPV vaccination in 90% of girls by age 15 years, high-performance test screening in 70% of women by age 35 years, and 90% of women with precancer treated and 90% with invasive cancer managed. In high-income countries, it is feasible to utilize advanced health care systems and prevention programs to surpass these goals.

Efforts to improve cervical cancer screening awareness in underscreened populations are also necessary. This can be accomplished using targeted and culturally relative communication approaches. Additionally, accessibility should be improved among these populations through the use of electronic innovations and more convenient locations.

Key recommendations from ACCESS include developing national cervical cancer elimination programs, implementing targeted education, improving screening accessibility, supporting health care professional participation, supporting the creation of national patient advocacy groups, and ensuring health insurance covers screening.

Follow-up after a positive HPV test or identification of abnormal cervical cell changes is also crucial. Treatment for precancerous lesions will vary depending on stage and severity of the precancer or cancer.

These guidelines highlight methods for improving cervical cancer screening and reducing the prevalence of mortalities. ACCESS concluded by stating, “Sampling by a healthcare professional should remain the preferred option for the majority of women, especially those who regularly attend clinician screening."

The consensusgroup also recommended that, "self-sampling should be reserved as an option for underscreened women who are habitual nonattenders."

References

1. Descamps P, Dixon S, Xavier Bosch Jose F, et al. Turning the tide—Recommendations to increase cervical cancer screening among women who are underscreened. International Journal of Gynecology & Obstetrics. 2024. doi:10.1002/ijgo.15600