2023-06-11T07:45:08
Cervical cancer is a leading cause of mortality among women. In 2020, an estimated 604 000 women were diagnosed with cervical cancer worldwide and about 342 000 women died from the disease. Cervical cancer is the most commonly diagnosed cancer in 23 countries and is the leading cause of cancer death in 36 countries. The vast majority of these countries are in sub-Saharan Africa, Melanesia, South America, and South-Eastern Asia.
1. WHO recommends using HPV DNA detection as the primary screening test rather than VIA or cytology in screening and treatment approaches among both the general population of women and women living with HIV.
Remarks: Existing programmes with quality-assured cytology as the primary screening test should be continued until HPV DNA testing is operational; existing programmes using VIA as the primary screening test should transition rapidly because of the inherent challenges with quality assurance.
2. WHO suggests using an HPV DNA primary screening test either with triage or without triage to prevent cervical cancer among the general population of women.
3a. In a screen-and-treat approach using HPV DNA detection as the primary screening test, WHO suggests treating women who test positive for HPV DNA among the general population of women.
3b. In a screen, triage and treat approach using HPV DNA detection as the primary screening test among the general population of women, WHO suggests using partial genotyping, colposcopy, VIA or cytology to triage women after a positive HPV DNA test (Annex 4).
Remarks: The benefits, harms and programmatic costs of the triage options are similar; therefore, the choice of triage method will be dependent on feasibility, training, programme quality assurance and resources in countries. HPV16/18 genotyping could be integrated into the HPV DNA test (refer to Annex 4 for specific details of the algorithms).
4. When providing HPV DNA testing, WHO suggests using either samples taken by a health-care provider or self-collected samples among both the general population of women and women living with HIV.
5. WHO recommends starting regular cervical cancer screening at the age of 30 years among the general population of women.
6. After the age of 50 years, WHO suggests screening is stopped after two consecutive negative screening results consistent with the recommended regular screening intervals among both the general population of women and women living with HIV.
Remarks: Neither VIA nor ablative treatment are suitable for screening or treatment of women in whom the transformation zone is not visible. Inadequate visualization is typical after the menopause.
7. Priority should be given to screening women aged 30–49 years in the general population of women. When tools are available to manage women aged 50–65 years, those in that age bracket who have never been screened should also be prioritized.
8. WHO suggests a regular screening interval of every 5 to 10 years when using HPV DNA detection as the primary screening test among the general population of women.
9. Where HPV DNA testing is not yet operational, WHO suggests a regular screening interval of every 3 years when using VIA or cytology as the primary screening test, among both the general population of women and women living with HIV.
10. While transitioning to a programme with a recommended regular screening interval, screening even just twice in a lifetime is beneficial among both the general population of women and women living with HIV.
11. WHO suggests that the general population of women who have screened positive on an HPV DNA primary screening test and then negative on a triage test are retested with HPV DNA testing at 24 months and, if negative, move to the recommended regular screening interval.
12. WHO suggests that women from the general population and women living with HIV who have screened positive on a cytology primary screening test and then have normal results on colposcopy are retested with HPV DNA testing at 12 months and, if negative, move to the recommended regular screening interval.
13. WHO suggests that women from the general population who have been treated for histologically confirmed CIN2/3 or adenocarcinoma in situ (AIS), or treated as a result of a positive screening test are retested at 12 months with HPV DNA testing when available, rather than with cytology or VIA or co-testing, and, if negative, move to the recommended regular screening interval.
14. As programmes introduce HPV DNA testing, use this test at the woman’s next routine screening date regardless of the test that was used at prior screening. In existing programmes with cytology or VIA as the primary screening test, rescreening with the same test should be continued until HPV DNA testing is operational among both the general population of women and women living with HIV.