The Health Information and Quality Authority (HIQA) is to conduct research to determine the optimum primary screening test for the prevention of cervical cancer in Ireland.

At the request of the National Screening Service, HIQA will undertake a health technology assessment (HTA) to independently evaluate the clinical, financial, ethical and organisational implications of establishing human papillomavirus (HPV) testing as the primary screening test for preventing cervical cancer. At present, liquid-based cytology is used as the primary screening tool by the National Cervical Screening Programme (CervicalCheck).

If low grade abnormalities are detected, the same sample is tested for HPV DNA to determine if the woman should be referred for colposcopy or back to routine screening. Changing the order of these tests, that is, using HPV DNA testing as the primary test followed by liquid-based cytology, has the potential to improve the detection of cancerous and pre-cancerous cell changes and to increase the efficiency of the screening process.

HIQA’s Director of Health Technology Assessment Dr Máirín Ryan said: “By examining international evidence on the clinical and cost-effectiveness of HPV testing — and by modelling these benefits, along with the budget impact of switching to HPV DNA testing for the Irish healthcare system — we will be in a position to provide independent advice on the optimal screening strategy for preventing cervical cancer in Ireland.”

HPV is a common virus usually spread by skin-to-skin contact during sexual contact. Most people will have HPV at some point in their lives, and in most cases it causes no symptoms and is cleared by the body’s immune system. However, persistent infection with a number of HPV virus types can lead to the development of cervical cancer.

An expert advisory group (EAG) comprising key stakeholder groups is currently being formed and will advise the HTA evaluation team during the course of this assessment.

The final results of the HTA are expected at the end of the year and will be submitted to the National Screening Service for consideration.

The Terms of Reference of the HTA are to:

• describe the epidemiology of cervical cancer and human papillomavirus in Ireland.
• examine the current evidence of efficacy and safety for human papillomavirus testing as a primary screening method for the prevention of cervical cancer.
• review the international cost-effectiveness literature of human papillomavirus testing as a primary screening method for the prevention of cervical cancer.
• estimate the clinical implications and cost-effectiveness of human papillomavirus testing as a primary screening test for the prevention of cervical cancer, including potential changes to the screening interval, age ranges and test sequencing compared with the current programme of liquid-based cytology screening.
• estimate the resource implications and budget impact of human papillomavirus testing as a primary screening test for the prevention of cervical cancer.
• consider any wider ethical or societal implications that human papillomavirus testing as a primary screening test for the prevention of cervical cancer may have for patients, the general public or the healthcare system.
• based on this assessment, advise on the optimal screening strategy for the prevention of cervical cancer.
   

Marty Whelan, Head of Communications and Stakeholder Engagement, HIQA
01 814 7480 / 086 2447 623 mwhelan@hiqa.ie

Ends.

• About 300 women are diagnosed with cervical cancer in Ireland each year. It is the eighth most common female cancer in Ireland.
• Cervical cancer is a cancer of the cells lining the cervix (neck of the womb). Most cervical cancers are caused by the HPV virus.
• There are over 100 different types of HPV. Most are low risk and do not cause changes to cervical cells. HPV infection can persist for many years without symptoms and is usually cleared by the body’s immune system. However, if the HPV infection does not clear up on its own, there is a greater risk of developing cervical abnormalities that require treatment.
• Vaccination against HPV can reduce the risk of developing cervical cancer.
• In 2010, on the advice of HIQA, the HSE began a HPV school immunisation programme for girls in their first year of secondary school, with a catch-up programme offered from 2011 to 2013 for 6th year pupils. The current vaccine being used protects against two high-risk HPV types (types 16 and 18) that cause seven out of every ten cases of cervical cancer.
• The National Cervical Screening Programme (CervicalCheck) for the prevention of cervical cancer commenced in Ireland in 2009. Women aged between 25 – 60 years are invited to attend for regular screening. Over 300,000 women were screened in the period 2013 to 2014. There has been a good uptake of screening, with 77% of the eligible population availing of the service in the five-year period to August 2014.