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Implementation of Primary HPV Testing in CSP in England

BAC statement in relation to the announcement that HPV primary screening will be implemented into the English cervical screening programme



As BAC members may well be aware, news started circulating earlier this week about a decision to implement Primary HPV testing within the English CSP. This appeared in several media outlets including the BBC and Daily Mail and has now been followed up by an official announcement to the programme via Regional SQAS.

The announcement reads:

PHE is delighted that Public Health Minister Jane Ellison has announced that HPV primary screening will be implemented into the English cervical screening programme. The implementation of HPV primary screening is a significant change and requires all aspects of the programme to be considered. Therefore there is a huge amount to do.

We have a well-established HPV primary screening implementation group with a programme of work already underway to address the challenges of implementation.  The group has extensive stakeholder representation from professionals in all parts of the cervical screening programme, HPV primary screening pilot sites, NHS England, Department of Health and the charities that support the programme.  We are working very closely with colleagues in NHS England who will commission the new service. 

There are critical issues that are not yet resolved, including the future configuration of cytology services. Now that the announcement has been made, we will be able to press on with more detailed planning with our NHS England colleagues. It is intended that the implementation of HPV primary screening will be a phased approach and could take up to 2019.

There is evidence that suggests HPV primary screening could support extending screening intervals, however, it is important to note that this has not yet been approved by the UK National Screening Committee (UK NSC) and a further proposal for extending screening intervals would need to be submitted to the UK NSC for assessment. 

Cervical screening in the UK has been a huge success story, due mainly to the really high quality of cervical cytology. The current method of screening, using cytology with HPV testing to help manage women with abnormalities, remains effective. However, the evidence is that HPV primary screening is slightly more sensitive and will be more effective, particularly in a vaccinated population. The skills of expert cytologists and cytopathologists will be crucial to allow us to continue to deliver an excellent service and help us achieve our aim to reduce the number of women who develop invasive cervical cancer.

This latest announcement re-iterates the decision of the National Screening Committee taken in November 2015 to recommend the move to Primary HPV testing with reflex cytology within the UK CSPs, which the BAC commented upon 

This new announcement indicates acceptance by the English government as to a definite implementation of this recommendation and suggests a possible implementation date of 2019 at the latest, building on the previous information

It is disappointing that such a major announcement as this is first heard through the media rather than through official communication routes, as this undermines confidence in the programme and morale within laboratories. The BAC will, as always, work with all bodies and structures to ensure that the move to Primary HPV is implemented in an effective and safe manner to continue the high quality of the existing CSP.

We would hope that now this decision has been made, that more detail on the exact process of implementation will be made available to allow for this transition and allow all those involved with the English CSP to plan for this.

It will have a major effect on laboratories and cytology staff, and we need to be able to plan with all other aspects of the CSP to deliver a high quality cervical screening programme to women.

The BAC on behalf of its members and all those working in the CSP, will be seeking more information about the implementation plans, and looking for regular updates.