European Society of Gynaecological Oncology/European Network of Gynaecological Advocacy Groups Position on risk-based cervical cancer screening.

The Risk-Based Screening for Cervical Cancer project was a 4-year Horizon 2020 European research consortium that developed and validated a risk-stratified approach to cervical cancer screening, moving away from the current one-size-fits-all model. The European Society of Gynecological Oncology and its network, the European Network of Gynecological Advocacy Groups, participated as partners, contributing their expertise from both professional medical society and patient advocacy perspectives. The project's key findings support replacing cytology with human papillomavirus (HPV) deoxyribonucleic acid testing as the primary screening modality, as it provides greater protection against invasive cervical cancer. Gender-neutral HPV vaccination is endorsed as a strategy to accelerate herd immunity, particularly where vaccination coverage falls short of the World Health Organization targets. HPV genotyping, alongside age and screening history, emerges as a critical tool for individualizing risk assessment, while methylation tests might be useful tools to significantly reduce unnecessary colposcopy referrals within a fully molecular approach to cervical cancer screening. For vaccinated cohorts specifically, the evidence supports longer screening intervals, more conservative management of high-grade lesions caused by non-vaccine HPV types, and the potential substitution of HPV genotyping for standard HPV testing. Self-sampling combined with polymerase chain reaction-based HPV testing is endorsed as a safe, effective strategy to increase participation, particularly among populations who are under-screened, with flexible access pathways recommended to address socioeconomic barriers. European Society of Gynecological Oncology/European Network of Gynecological Advocacy Groups formally endorse the Risk-Based Screening for Cervical Cancer recommendations and call for the reform of European cervical cancer screening programs through the adoption of risk-stratified, patient-centered strategies, supported by integrated population registries, standardized quality indicators, and continuous real-time monitoring of vaccination and screening outcomes.