European guidelines on cervical cancer screening and diagnosis

Should HPV detection test until 69 years vs. HPV detection test until 64 years be used as the primary screening test for cervical screening in asymptomatic populations with cervix?

The WG bases this recommendation on the small benefits of screening that an additional round could add in this age group. The WG highlights that, in a regularly screened population, the likelihood of identifying new CIN2+ lesions in this age group is low, and that overall life years gained would also deem screening at 65 years or older not cost-effective. Considering both the average life expectancy in Europe (83 years) and the natural history of CIN2+ lesions, the WG also considered that competitive mortality from other causes becomes an important consideration, supporting their recommendation that the benefits of screening would be limited at 65 years or older. Harms related to cervical precancer treatment may be high in this age group.

This recommendation applies to general populations with cervix at average risk. Specific guidance for both higher-risk (immunocompromised) and lower-risk (vaccinated) populations will be detailed in later recommendations. 

The WG stresses that successful implementation depends on maintaining robust and adaptable monitoring systems that reflect the new realities of HPV-based screening programmes. 

The WG highlighted the importance of closely monitoring the impact of HPV-based screening programmes especially as they transition from cytology-based screening. The European Quality Assurance Scheme, currently being developed under EC-CvC, will play a central role in supporting countries to monitor the implementation of this recommendation, ensuring that changes are evidence-based and do not lead to unintended consequences. The WG stressed that successful implementation depends on maintaining robust and adaptable monitoring systems that reflect the new realities of HPV-based screening programmes.

The EC-CvC WG considered the following research priorities:

• Evaluation of benefits and harms of different screening stopping ages using age-stratified observational data, especially in populations with multiple rounds of HPV testing
• Evaluation of age-specific risks of treatment and overtreatment, particularly in individuals aged 65 and older
• Feasibility and effectiveness of tailoring screening cessation based on screening history rather than a fixed age
• Understanding the natural history of CIN3+ in older individuals, including progression risk versus competing mortality
• Understanding HPV dynamics and persistent infections in older individuals, in the context of increased life expectancy and prior screening exposure
• Evaluation of equity and outcomes from catch-up screening in previously under-screened populations
• Evaluation of age-specific colposcopy outcomes, including unsatisfactory procedures, downstream interventions, and treatment-related harms.