WHO releases new recommendations to prevent cervical cancer through increased access to screening and treatment

The World Health Organization (WHO) and the Human Reproduction Program (HRP) have released new guidelines with recommendations for cervical cancer screening and treatment to inspire rapid progress and improvement. greater equity, according to a press release from the World Health Organization.¹

These new guidelines, as part of WHO’s global strategy to eliminate cervical cancer, set the goal of regularly screening 70% of women worldwide for cervical disease. uterus with a high-performance test by 2030. The guidelines also detail a plan to immunize 90% of girls against human papillomavirus (HPV), which could prevent 62 million deaths over the next 100 years. In addition, the global strategy aimed to provide appropriate and accessible care to 90% of women who tested positive for a cervical injury.

“This new WHO guideline will guide public health investments in better diagnostic tools, stronger implementation processes and more acceptable screening options to reach more women and save more lives,” Princess Nono Simelela, MD, deputy director general for strategic programmatic priorities: Cervical Cancer Elimination at WHO, said in a press release.²

Recommendations for the general population

A total of 604,000 women are diagnosed with cervical cancer and 342,000 die each year from the disease worldwide in 2020. Currently, the WHO recommends a DNA-based HPV test rather than a visual inspection with acetic acid (VIA) or cytology – the most common in the detection of precancerous lesions, both in the general population and in women living with human immunodeficiency virus (HIV).

HPV DNA tests detect high-risk strains of HPV that are known to cause almost all cervical cancer. Being an objective diagnostic test, the method leaves little need to interpret the test results. The test is also simpler, cost effective, and saves more lives than IVA or cytology. WHO also noted that self-collected samples would be acceptable for this type of testing.

Until the new HPV DNA test is operational, the primary screening to use should always be cytology. Those still using VIA should make a quick transition due to the challenges associated with quality assurance. Additionally, when using a screening and treatment approach with an HPV DNA test as the primary test, those who test positive should begin treatment.

The general female population should begin regular screening for cervical cancer at age 30. Women aged 30 to 49 should benefit from priority screening in this population. In addition, people aged 50 to 65 who have never been screened should be given priority. A regular screening interval every 5 to 10 years is recommended for the general population who receive HPV DNA detection as the primary screening method.

Recommendations for women living with HIV and cervical cancer

HPV DNA is also recommended for women living with HIV by VIA or cytology. The guidelines also recommended that women living with HIV get an HPV DNA test with triage to help prevent the disease. For those using a screening, triage, and treatment approach with detection of HPV DNA as the primary test, guidelines recommend using high-risk HPV DNA testing, cytology, VIA , partial genotyping and colposcopy. It is also recommended to start screening at age 25 rather than the recommended age 30 for the general population. In addition, women with HIV should be tested more frequently if they are HPV positive.

Priority testing should also be given to HIV-positive patients aged 25 to 49. Like the general population, patients aged 50 to 65 who have never been tested should also be given priority. In addition, a regular screening interval every 3 to 5 years is recommended for people living with HIV. The use of IVA or cytology is recommended every 3 years for facilities where HPV DNA testing is not yet available.

Actions that can be taken for the general population and people living with HIV

The guidelines also detailed a number of recommendations that applied to both the general population and women living with HIV. For women 50 years of age or older, it is recommended to stop testing after 2 consecutive negative results, although guidelines recommend regular testing intervals.

WHO suggested that if women had a positive cytologic screening followed by normal colposcopy results, should be retested within 12 months using the HPV DNA test; if they are negative, they can resume the recommended regular screening interval. Other recommendations state that once the decision to treat is made, treatment should take place within 6 months to reduce the risk of loss of follow-up. WHO also recommends the use of large loop excision of the transformation zone or cold knife conization for the two groups of patients who have histologically confirmed adenocarcinoma in situ.

“Effective and accessible cervical screening and treatment programs in all countries are not negotiable if we are to end the unimaginable suffering caused by cervical cancer,” Simelela concluded.

The references:

• WHO. WHO guideline for the screening and treatment of precancerous lesions of the cervix for the prevention of cervical cancer, second edition. Cervical cancer, version 6.2021. Accessed August 17, 2021. https://bit.ly/3sxg5Ag
• New screening and treatment recommendations to prevent cervical cancer. Press release. World Health Organization. July 6, 2021. Accessed August 17, 2021. https://bit.ly/3m91Wb4