What's next? Perspectives and future needs of cervical screening in Europe in the era of molecular testing and vaccination.

AIM: To outline the perspectives for future control of cervical cancer in Europe.

METHODS

Review of current status for major cervical cancer control tools. The review was based on PubMed searches for cervical cancer prevention, Human Papillomavirus, HPV-test, HPV-vaccination, and treatment with large loop excision of the transformation zone, LLETZ.

RESULTS

Recent studies suggest that condom use offers some but not complete protection against HPV-infection. High quality cytology screening with good population coverage reduces the incidence and mortality of cervical cancer. Randomised controlled trials have found HPV-testing to increase the detection rate of cervical intraepithelial neoplasia grade 2+, CIN2+, compared with cytology. Two studies found a decreased detection rate of CIN3+ in the HPV-testing arm at the subsequent screening. Randomised controlled trials found that women not infected with vaccine HPV-types at vaccination are well protected against CIN2+ from these HPV-types, but the vaccine does not protect against CIN2+ from other HPV-types and neither does it protect already HPV infected women. There is an increased risk of adverse obstetric outcomes following excisional treatment.

CONCLUSIONS

The future of cervical cancer control may become a diversified strategy, one for non-vaccinated birth cohorts and another for vaccinated cohorts. It will take another 50 years before the non-vaccinated cohorts have passed the screening age. With the current uncertainty concerning the long term protection from HPV-vaccination it will furthermore be precautionary to continue screening practice for the first cohorts of HPV-vaccinated women. Organised vaccination and screening programmes with good record keeping are necessary to optimise the future control of cervical cancer.