<![CDATA[HPV 2020: the personal perspective of Dr. Joakim Dillner]]>

How has the cervical cancer screening transition from cytology-based to HPV-based been in the nordic countries?

Initially, a very well organised randomised implementation in defined phases. Then there were governmental decisions on that there should be routine HPV screening everywhere. However, healthcare is organized in independent regions. All the regions say that they will do it, but still 5 years after the decision several regions did not introduce it. The situation could be described as chaotic and is problematic for the safety of the women.

Which are the current recommendations and the main barriers for its implementation?

The 2015 national program in Sweden mandates cytology-based screening ages 23-29, HPV screening at ages 30-70. The interval is every 3 years from 23-49 and every 7 years from 50-70. There is also a double test with both cytology and HPV at age 40. It is not entirely clear why the decision is not implemented in some regions, it appears to not be a priority. Implementation was fast in regions who had active HPV laboratories.

How will vaccination against HPV modify cervical cancer screening programs?

We think that birth cohorts who have had a high population coverage of HPV vaccination should simply not be screened. Already there is mostly non-progressive lesions found among the vaccinated, questioning whether screening is beneficial to these women.

Which options are currently being considered to simplify HPV screening?

Screening only for HPV16 and 18 in younger cohorts and only for the 7 vaccine-targeted types among older women. As the number of samples taken will be decreasing, there will also be a switch to more self-sampling.

Which are the preliminary results in the countries were screening programs have been modified?

The cancer-protective effect is the same. There is an increased CIN2 yield. A marginally greater amount of referrals. Lower use of resources.

Which is your opinion regarding extending HPV vaccination programs to middle aged women (25-45 years of age) as an alternative to cervical cancer screening?

It is time to stop just talking and actually do implementation trials along these lines. WHO calls for innovation on how to accelerate the elimination of cervical cancer and this is a prime option for this. Implementation trials should start in the age group where the benefit of vaccination is the highest and reduction of screening carries the most benefit, that is in the youngest age group attending the screening program.

Do you have any special message for IPVC2020?

We are at a critical time point in the history of cervical cancer elimination. We have all the tools for effective vaccination and screening. Everyone wants cervical cancer to be eliminated. Innovation on how to accelerate the elimination could mean the difference between achieving elimination in just a few years versus 100 years later or maybe never. We need an inspiring meeting with a critical mass of dedicated and creative individuals to promote progress and I would like to urge the participants of IPVC2020 to take this opportunity to make a difference.

DISCLOSURE JD has previously been recipient of research grants to his institution from Merck, a manufacturer of HPV vaccines. His university (Karolinska Institutet) has ongoing contracts with Merck and his hospital (Karolinska University Hospital) has ongoing contracts with several manufacturers of HPV diagnostics, including Roche and Genomica.

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Joakim Dillner, PhD, MD
Professor, Center for Cervical
Cancer Prevention,
Karolinska University Laboratory,
Karolinska University Hospital,
Stockholm, Sweden.
Joakim.Dillner@ki.se

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