Abstract: Improvements in the performance of cervical screening may be limited by the diagnostic performance of colposcopy. Nonetheless, colposcopy remains the best available tool to assess women considered at high risk for having or developing cervical cancer. The provision and role of colposcopy across Europe is variable. Introduction of vaccination against human papillomavirus (HPV) types 16 and 18 as well as the possible switch to HPV-based screening is likely to change the profiles of women presenting to colposcopy services and provide management difficulties for the colposcopist.
The standard of colposcopy in Europe can be maintained or improved despite a variable availability of screening. The prevalence of cervical intraepithelial neoplasia grade 3 may decrease for women having had HPV vaccination. The incidence of cervical intraepithelial neoplasia grade 3 and cervical cancer in second and subsequent rounds of HPV-based screening are likely to decrease compared to cytology-based screening. In HPV-based screening, the numbers of women with no detectable or minor abnormalities at colposcopy and with screen-detected glandular disease are likely to increase. We have considered how these issues will affect states that have varying implementation of organized cervical screening programs and varying degrees of implementation of HPV testing or vaccination.
The development of quality assurance across Europe accompanying these program changes is discussed.
Trained colposcopists performing colposcopy supported with rigorous quality control should have the skills capable of adapting to changes in various European cervical screening programs.
1Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK; 2Department of Gynecology, National Screening Center, Tbilisi, Georgia; 3Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium; 4Laboratoire Cerba, Paris, France; 5Department of Gynecology and Obstetrics, University of Bari, Bari, Italy; 6Hôpital Tenon, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Paris, France; 7Department of Obstetrics and Gynecology, Helsinki University Hospital, Finland; 8The Beacon Hospital, Sandyford, Dublin, Ireland; 9Department of Obstetrics and Gynaecology, University Hospital of North Staffordshire, Stoke-on-Trent, UK; 10D-18437 Stralsund, Grünthal, Germany; and 11Department of Obstetrics and Gynaecology, Klinikum Wolfsburg, Wolfsburg, Germany
Reprint requests to: Simon C. Leeson, FRCS, FRCOG, Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board (West), Gwynedd, Wales LL57 2PW, UK. E-mail: email@example.com
Dr Arbyn participated in the EUROGIN conference (Lisbon 2011) funded by organizers of the conference. Dr Arbyn received financial support from (1) Directorate of SANCO of the European Commission, Luxembourg, Grand-Duchy of Luxembourg), through the ECCG project (European Cooperation on development and implementation of Cancer screening and prevention Guidelines, the IARC, Lyon, France); (2) the 7th Framework Programme of DG Research of the European Commission through the PREHDICT project (grant no. 242061, coordinated by the Vrije Universiteit Amsterdam, the Netherlands) and the HPV-AHEAD project (FP7-HEALTH-2011-282562, coordinated by IARC); and (3) the Belgian Foundation Against Cancer (Brussels, Belgium). Dr Petry received unrestricted research grant from Sanofi Pasteur MSD for an HPV epidemiology study and a speaker’s honorarium from Roche, Qiagen, GSK, and Becton Dickinson Ad Board.
The other authors have declared they have no conflicts of interest.