Cervical Cancer Screening Methods Reevaluated after Seventeen Years

There are few diseases in the world that reflect health asymmetries as starkly as cervical cancer. A preventable and treatable cancer, with 90% of the new cases and deaths worldwide, affecting women in low- and middle-income countries.

In 2020, the World Health Assembly adopted an ambitious yet achievable resolution to eliminate cervical cancer as a public health problem. To support this global endeavour, the International Agency for Research on Cancer (IARC) convened a Working Group of 27 independent experts, including ISGlobal Associate Researcher Silvia de Sanjosé, to review the scientific evidence and assess the cancer-preventive and adverse effects of various methods of screening for cervical cancer. The new IARC Handbooks of Cancer Prevention Volume 18 published in May 2022, is the result of this review process. This is an important update on cervical cancer screening methods as the previous evaluation took place in 2005.

One of the three pillars to achieve the elimination goal includes a target of screening 70% of women using a high-performance test, first by the age of 35, and second by the age of 45. As defined by the World Health Organization (WHO), “Screening is the systematic application of a screening test in a presumably asymptomatic population. It aims to identify individuals with an abnormality suggestive of a specific cancer. These individuals require further investigation.”

One of the major findings from this reevaluation confirms that human papillomavirus (HPV) testing is the most effective method of screening for cervical cancer given its balance of benefits and harms, as compared to other methods like cytology or visual inspection with acetic acid.

According to de Sanjosé, “This is a crucial time as countries are gearing up to meet the 2030 targets, following the launch of the WHO global elimination strategy. Screening technology has considerably evolved since the last evaluation in 2005 and this publication will be helpful for countries seeking to update their screening protocols.”

“Cervical cancer is more than just a disease. It is an indicator of weak health systems and low prioritization of women’s wellbeing. One can assume that the day we eliminate cervical cancer as a public health problem, we will have made tremendous progress in other human development indicators, especially related to gender and health,” explains ISGlobal researcher.

The systematic review process behind this IARC Handbook includes eight steps for identification, screening, synthesis, and evaluation of the evidence. This updated evaluation is especially important as it is also based on studies conducted in real-life situations, unlike the previous evaluations which were mostly based on trials and test accuracy studies. On the basis of the criteria defined in the Handbooks Preamble, the screening method is classified into Group A, B, C, or D, depending on how effective it is at reducing the incidence of cancer of the target organ or reducing mortality from cancer of the target organ.