By Susan Donlon, Communications Team, National Screening Service
We joined leading international experts and stakeholders active in the field of cancer policy and women’s health for an EU Policy event on cervical cancer at the European Parliament in Brussels on 25 January 2024.
Dr Mairead O’Connor, Research Officer with the National Screening Service and member of the ACCESS International Consensus Group on Cervical Cancer, took part in an expert discussion at the event on ways to increase participation in cervical cancer screening among under-served groups.
Welcoming everyone to the event, Dr Tomislav Sokol MEP said that healthcare has become a priority discussion in European Parliament, particularly Europe’s Beating Cancer Plan and its focus on prevention and early detection. “A good example of prevention and early detection is through screening” Dr Sokol said. Cervical cancer rates can be significantly reduced if we “strongly invest in screening and early detection plans”.
Prof Philippe Descamps, Co-Chair of the ACCESS Consensus Group, presented the group’s White Paper ‘Turning the tide: Recommendations to increase cervical cancer screening among women who are under-screened’.
The White Paper is intended for policy makers and has six key recommendations:
- Develop cervical cancer national elimination plans with goals for elimination by a defined date.
- Implement targeted and culturally relevant education, information and awareness-raising initiatives particularly focused on the under-screened population.
- Improve accessibility of cervical cancer screening for under-screened populations.
- Support healthcare professionals to increase participation in cervical cancer screening and encourage a partnership approach between healthcare professionals and patients.
- Encourage and support the creation of national cervical cancer patient advocacy groups.
- Ensure that health insurance appropriately covers screening in all high-income countries.
Cervical cancer is a leading cause of mortality among women in the EU with 33,000 cases of cervical cancer and 15,000 deaths each year. Research in Europe has shown women who attend regular screening reduce their risk of dying from cervical cancer by up to 92%. Since the 1980s, national screening programmes have helped to reduce cervical cancer rates by up to 80% in high-income countries with established screening programmes. “Screening works,” Prof Descamps said.
“There is an opportunity to eliminate a cancer for the first time.” HPV vaccinations work and vaccination is crucial, but its effects are expected to be longer-term, Prof Descamps explained. “Screening programmes remain the most powerful tool to reduce cervical cancer rates in the near term.”
Discussions and presentations focused on how to improve uptake of screening among women who are disproportionately affected by cervical cancer – disadvantaged groups who are most likely to be under-screened. There has been a concerning decline in screening participation in some higher-income countries with established screening programmes. Rates vary between countries with some at 80% participation and some as low as 25%.
During the roundtable discussion, Dr Mairead O’Connor said that Ireland has experienced similar trends. There are sub-groups of women not attending for screening, Dr O’Connor explained, including immigrants, travellers, the LGBT community and people with physical disabilities and intellectual disabilities. Dr O’Connor highlighted her own research on the psychological impact of cervical screening, which is often overlooked. “Using innovative approaches to screening, such as providing access outside of a clinical environment,” needs to be explored. Dr O’Connor said there are positive trends in cervical cancer diagnosis and treatment in Ireland with incidence and mortality reducing year on year.
Dr O’Connor outlined some of the work in the National Screening Service to address barriers to screening and increase participation. These examples are cited as best practice in the ACCESS Consensus Group’s White Paper:
- our national roadmap to Cervical Cancer Elimination and Ireland’s recent announcement that we’re on target to eliminate cervical cancer by 2040
- our strategic framework to improve equity in screening which aims to address the barriers that can prevent people from taking part in screening programmes
- our collaborative work with the World Health Organization’s International Agency for Research on Cancer (IARC) developing recommendations on best practices in cervical cancer screening programmes to address global issues relating to the quality and coverage of cervical cancer screening programmes.
The introduction of HPV self-sampling as an option to increase participation in cervical screening was discussed. The first data from countries that have already been providing a self-sampling option is “not unanimously positive” Dr Matejka Rebolj, Senior Epidemiologist at Queen Mary University of London explained. Some countries are reporting that it has not increased participation in screening, and in some cases women who test positive for HPV are not attending for follow-up appointments.
Dr Rebolj said while self-sampling is not a simple fix and is not a like-for-like replacement for clinician sampling, countries should “not delay the introduction of self-sampling for under-screened and never-screened women”.
“We have not yet seen the full potential of self-sampling,” Dr Rebolj said. “We need to use self-sampling in a wise way, to reach the women we need to reach, to increase participation in under-screened women.”
As part of the European Commission (EC) initiative on cervical cancer (EC-CvC) and Europe’s Beating Cancer Plan, IARC and the EC Joint Research Centre are developing screening guidelines and quality assurance schemes for Europe.
The EC-CvC will develop European clinical practice guidelines for cervical cancer primary prevention, screening and diagnosis, Dr Partha Basu, Head Early Detection, Prevention & Infections Branch, with IARC explained; and the European quality assurance scheme will cover the entire cancer care pathway, including treatment, palliative care and survivorship.
Dr Basu said the new guidelines will include recommendations for screening:
- on how to improve participation in screening among disadvantaged groups
- the management of screened-positive women
- how to improve accessibility of cervical cancer screening for under-screened populations
- how to support healthcare professionals to increase participation in cervical screening.
In the final presentation at the event, Domenico Fiorenza, Cancer Policy Officer with the European Commission spoke about the EU cancer prevention initiatives highlighting that one of the flagship actions of Europe’s Beating Cancer Plan is Cervical Cancer Elimination.
Closing the event, Prof Descamps reiterated the success of established screening programmes in preventing cervical cancer and reducing cervical cancer incidence. Encouraging women to attend screening will reduce their risk of dying from this cancer, he said. “Cervical cancer is a major health problem that we have to fight together.”
- Other speakers addressing the event included Samira Rafaela MEP; Sirpa Pietikäinen MEP; Martin Hunt, Chief Executive of Jo’s Cervical Cancer Trust UK and Co-Chair ACCESS Consensus Group; Esra Urkmez, Patient Advocate; Ody Neisingh, Member of the ACCESS Consensus Group, Independent Consultant & Public Affairs Advisor.
- The ACCESS International Consensus Group is made up of professionals with a broad range of experience and expertise in women’s health — focusing on cervical cancer from clinical, epidemiological, academic, patient, and advocacy perspectives. The group works to review the latest available evidence that supports optimal cervical cancer screening strategies in countries with organised cervical cancer screening programmes and makes recommendations to relevant stakeholders and policymakers to advance women’s health by increasing the uptake of screening amongst under-screened women.