Cervical screening to be enhanced with test for HPV (1)

Monday, 25 February 2013

Cervical Cancer - a preventable disease Women in the Isle of Man who take part in the Cervical Screening Programme (formerly known as a ‘smear test’) and who’s results show the least serious abnormalities (borderline or mild dyskaryosis) will now benefit from an additional test on their sample, with the introduction of screening for the Human Papilloma Virus (HPV).

High risk types of HPV cause the majority of cervical cancers. Everyone carries HPV, both men and women, with over 120 strains of the virus known to exist. Some strains present a higher risk to women than others, as they have the potential to cause the development of abnormal cell growth in the cervix. These abnormalities can easily be treated before becoming dangerous – which is why it’s so important for women to attend screening.

Following research and trials over many years, it is now possible to screen for high risk HPV as part of the existing Cervical Screening Programme when a borderline or mildly abnormal result is detected. This information can then be used to determine what course of action to take. If high risk HPV is detected, then a colposcopy will now be undertaken immediately (a procedure to examine surface of the cervix using a magnifying instrument called a colposcope), whereas previously women would be monitored, with a follow-up screening after 6 months and again after 12 months. If high risk HPV is not detected, women can be reassured and can return to routine cervical screening without follow-up.

Women being followed-up after treatment for abnormal cells will also notice a change - their cervical screening sample will now be tested for high risk HPV, and if a high risk strain of the virus is found, women will be reviewed in the colposcopy clinic. If negative, they can be reassured and will have their cervical screening repeated in three years, as opposed to annual tests for up to 10 years as currently happens.

The test for high risk HPV is done on the one cervical screening sample and only when a borderline or mildly abnormal result is detected, which means that women will not notice anything different when they have their test. Women who have a moderate or severe abnormality will still be referred for a colposcopy immediately, and won’t therefore require testing for high risk HPV as part of the screening process.

As both screening for abnormal cells and any subsequent tests for HPV are done from a single sample, women will still only need to undergo the one regular routine screening. As a result, adding screening for HPV is cost neutral, with no additional money required to fund it.

Minister for Health, David Anderson MHK, said:

'As part of the Department of Health’s overarching strategy, we continue to focus on prevention over cure, most recently demonstrated with the introduction of Bowel Screening on the Island in 2011. This latest development in screening will enable us to improve care for women and goes hand in hand with our HPV vaccination programme for girls aged 12 to 13, which launched in 2010. HPV causes the majority of cervical cancers, and as such the Department operates a two pronged approach to prevent cancer of the cervix from developing. The first line of defence is preventing transmission of HPV by vaccinating girls who are in school year 8. In addition, the Cervical Screening Programme continues to see women, screening for any abnormalities, and – if found – also test for high risk HPV, providing early intervention if necessary. Through this action, it is hoped that in the years and decades ahead, many of the cervical cancer cases we see today can be prevented, saving many lives.'

Mr Bob Fayle, Consultant Obstetrician and Gynaecologist, and Clinical Director of the Women, Children and Outpatients Division at Noble’s Hospital, said:

'As a result of the HPV screening, it will be much easier to identify those women who are potentially at risk of going on to develop cancer and avoid unnecessary referral and treatment of low risk women. Being called for further examination in the colposcopy clinic is nothing for women to be alarmed about, the vast majority of abnormalities are easily diagnosed and treated in the clinic.

'This is a very positive development in cervical screening, and is based on extensive research and an increasing understanding of the role of HPV in the development of cancer of the cervix. It will reduce the number of unnecessary referrals for investigation in the colposcopy clinic, give women with borderline test results a clear answer without them needing to attend for repeat tests, and also give a clear indication of the success of treatment while at the same time reducing the number of follow-up tests women need to have.'

All women in the Isle of Man aged between 25 and 49 years of age are called for Cervical Screening every three years. Those aged 50 – 64 are called every five years. Further information on the Island’s Cervical Screening Programme can be found at www.gov.im/health/services/Public_Health/HI/Screening/cervical.xml

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