DNA-based testing for human papillomavirus (HPV) has been shown to be more effective than today’s commonly used screening methods aimed at detecting and preventing cervical cancer, a major cause of death among women worldwide. The recently published “WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention” recommends the use of such DNA-based HPV testing as a first choice screening method.
In 2020, more than 600 000 women were diagnosed with cervical cancer worldwide and about 342 000 women died from the disease. In the WHO European Region, 30 000 women die from cervical cancer every year.
“These deaths can be avoided. Thanks to screening, and notably using the new HPV DNA-based tests, cervical cancer can either be prevented or detected at early stages and cured. WHO has renewed its recommendations for screening and treatment of cervical cancer, making clear that HPV DNA-based tests are more efficient than cytology-based tests, especially for low- and middle-income countries, because they are less prone to quality problems,” said Dr Marilys Corbex, Senior Technical Officer on noncommunicable diseases, WHO/Europe.
Detecting the cancer-causing virus
Cervical cancer is caused by HPV, a very common group of viruses, which have no symptoms that are easy to detect, affecting the skin in the mouth, throat or genital area.
Just 2 high-risk HPV strains (16 and 18) cause more than 70% of cervical cancers, but can be treated if detected early enough. So, alongside nation-wide vaccination of girls against HPV, WHO recommends that countries ensure regular DNA-based testing for HPV to identify women who have or are at risk of cervical pre-cancer.
HPV DNA-based tests proved to be more effective in preventing cervical cancer than methods that are commonly used in the European Region today, based on cytology (commonly known as a “Pap smear”). The DNA-based testing is also less prone to human errors, unlike tests that rely on visual inspection. HPV-DNA testing is an objective diagnostic, leaving no space for interpretation of results.
WHO recommendations for different population groups
The new WHO cervical cancer prevention guideline renews the previous one published in 2013. It features a total of 7 good practice statements and 23 recommendations, some of which are different for the general population of women and women living with HIV.
In summary, there are 2 major changes:
- For the general population of women, HPV-DNA detection is recommended as the primary screening method – starting at the age of 30 years, with regular testing every 5–10 years.
- For women living with HIV, WHO recommends HPV-DNA detection starting at the age of 25 years, with regular screening every 3–5 years.
Eliminating life-threatening cancer
“HPV-DNA tests are relatively new tools, and some countries are only beginning to implement them as part of their cervical cancer screening systems. WHO encourages and supports these changes,” said Dr Corbex. “In addition, DNA tests make it possible to redesign screening programmes to improve their quality, which is necessary on the way to eliminating cancer as a life-threatening disease in the WHO European Region and beyond.”
“Screening is not only the test itself, it is all that happens afterwards in cases where the woman is tested positive for cervical cancer. If further diagnostics and treatment components are not perfectly organized and not performed with high quality standards, advanced testing methods can be considered useless,” added Dr Corbex.
In countries with effective cytology-based cervical cancer screening and treatment programmes, the mortality from cervical cancer has been reduced fivefold over the past 50 years. Yet, this approach has not been as successful in low- and middle-income countries.
HPV DNA-based screening tests are more cost-efficient and are suitable for all settings, areas and countries. This is in line with the WHO European Programme of Work 2020–2025, which is based on the idea that health is a universal value, and no one should be left behind in access to health care.
In 2020, WHO launched the Global Strategy to Accelerate the Elimination of Cervical Cancer. The goals of the strategy are, by 2030:
- to vaccinate 90% of eligible girls against HPV;
- to screen 70% of eligible women at least twice in their lifetimes;
- to effectively treat 90% of those with a positive screening test or a cervical lesion, including with palliative care when needed.