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Delays to HPV screening cost £3 million and miss 48 cervical cancer cases every month

A one-year delay in introducing human papillomavirus (HPV) testing as the main test in cervical screening would miss the opportunity to prevent 581 cases of cervical cancer in England at an estimated value of £32 million in lost quality of life, according to a study by researchers at Queen Mary University of London and King’s College London.

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A cytologic smear under the microscope
A cytologic smear under the microscope

In England, screening for cervical cancer is currently done through the Pap smear, which involves the collection, staining and microscopic examination of cells from the cervix. If any abnormal cells are found, they remove them to stop cervical cancer developing. The cervical screening programme in the UK today is estimated to save 2,000 lives a year.

It was established a decade ago that testing for the presence of HPV – the virus that causes cervical cancer – is a better cervical screening test than the Pap smear. Public Health England and the NHS, who are responsible for the screening programme in England, have until recently aimed to switch from the Pap smear to HPV testing in April 2019, but are now working towards a December 2019 deadline.

A heavy price to pay for being overcautious

This study, funded by Cancer Research UK and published in the Journal of Medical Screening, has for the first time attempted to put a monetary value on the benefits of early adoption of HPV primary screening. The authors say that while careful planning is essential, sometimes there is a heavy price to pay for being overcautious.

The paper, points out that more than 30 years have passed since HPV was first associated with cervical cancer. The US led the way in introducing HPV-based screening in the mid-2000s. By contrast the pace in the EU has been considerably slower - Netherlands and Sweden’s implementation of HPV testing was delayed until 2017, while Italy’s rollout should be completed by the end of this year.

Ministries of health should consider cost of delay

Professor Peter Sasieni said: “We are not trying to lay blame for the slow introduction of HPV primary screening in the EU compared with North America. But simply to point out that there is a cost to pay for being overly cautious. Undoubtedly, more rapid introduction would have required additional investment, but it is staggering to think that the saving in terms of years of life gained would amount to some £32 million per year the introduction is delayed.”

The new study finds that for every month the implementation of HPV primary testing is postponed in England, there would be a missed opportunity to diagnose 48 additional women with cervical cancer, at an estimated value of £2.7-3.8 million in lost quality of life.

First author Dr Alejandra Castañon said: “We were shocked by the huge cost of delayed introduction. We want ministries of health and public health departments to balance the cost of overly hasty implementation of a proven intervention against the cost of delay when planning roll-out.”

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