Cervical screening programme: HPV triage and test of cure protocol
Testing for high-risk human papillomavirus (HR-HPV) as triage and test of cure was introduced into the Northern Ireland Cervical Screening Programme on Monday 28 January 2013. This policy change will significantly alter the screening pathway for women with a mild dyskaryosis or borderline test result.
The link between HR-HPV infection and the development of cervical cancer has now been clearly established, with almost 100% of cervical cancers containing HPV DNA. Women with no evidence of HR-HPV infection are extremely unlikely to develop cervical cancer in the short to medium term.
HPV triage is the process whereby HR-HPV testing is used to manage women with low grade cervical abnormalities. Only 15-20% of women with a borderline or mild test result have a significant abnormality that needs treatment. HR-HPV testing is effective in identifying which women may need treatment and allows colposcopy resources to be allocated more effectively.
The test of cure process is being introduced because it is now known that women with a normal or low grade test result, and who are HR-HPV negative at six months after treatment, are at very low risk of residual disease. These women do not need to be recalled for another screening appointment for three years.
The test of cure process means all post-treatment tests (at six months) that are reported as normal, borderline or mild dyskaryosis will be tested for HR-HPV. Those women who are HR-HPV positive will remain at colposcopy. HR-HPV negative women can be safely returned to recall in three years. It is estimated that the HR-HPV test of cure will allow approximately 80% of women who have been through treatment to avoid undergoing annual screening tests.
This flowchart poster outlines the new triage and test of cure process. It was distributed to all GPs in Northern Ireland and is available to download as a PDF from this website.