International Papillomavirus Conference (IPVC) 2024

The International Papillomavirus Conference (IPVC) took place in Edinburgh from 12-15 November 2024. The event was attended by approximately 1856 delegates from 100 different countries, including clinicians, policy makers and third sector organisations, convened to discuss HPV and papillomavirus issues across a number of different events and sessions.

I would like to thank the Scottish Cervical Screening Programme (SCSP) for funding my attendance at this fascinating and transformational conference. It is not often that I return from a conference feeling that I have learned about a new approach to screening, and I am grateful for all the speakers and delegates who were open and transparent about their screening programmes and enthusiastic to share their learning and data.

The purpose of the International Papillomavirus Society (IPVS) has been to promote worldwide exchange of ideas, knowledge, and research materials among basic, clinical and public health research professionals concerned with human and animal papillomaviruses and their associated diseases. IPVS also strives to facilitate research, and to promote the translation of research results into new clinical applications and public health policies. IPVS serves as the organizational structure for the field of biomedical scientists, physicians and other health care providers engaged in all manner of papillomavirus research.

The key points from this fascinating conference are as follows:

Cervical Screening

• The New Zealand model for self-sampling may be of particular interest to the UK screening programmes. Similar to what is used in YouScreen and in Australia, this model utilises self-sampling kits within primary care settings, rather than sending kits out by post. This approach was used successfully in the north island of New Zealand to increase participation in Maori communities that the national screening programme had failed to reach.

• Dr Patti Gravitt (Senior Advisor for Population and Systems Sciences, Centre for Global Health) highlighted that language around HPV “latent infection” is sometimes used without due consideration of its clinical significance. A deeper understanding of language used, and the pathway of HPV infection is needed to more appropriately communicate with women and manage expectations around true clearance of HPV infection.
• A session focussed on inequalities considered the benefits of appointing screening champions, rather than screening “being done to people” in a top-down way. Organising screening champions within a community, who know how to engage with individuals who are less likely to be screened, can help to encourage them to attend screening appointments. This approach proved successful in Pennsylvania and in New Zealand. It is interesting to think about who these “screening champions” could be within your local communities.
• The invasive cancer audit has clearly demonstrated that the majority of cervical cancers within the UK are in unscreened women or in women who have not attended regularly. Incidence and mortality will only fall if screening programmes engage with these individuals. Incidence of cervical cancer is also closely linked to deprivation and has been named the “cancer of inequality”.
• An example of this is work carried out in England by Dr Floor Christie-de Jong, who worked with faith groups in the Muslim community to increase attendance at screening appointments.
• Ireland’s Cervical Cancer Elimination Action Plan also includes a Community Champions pilot programme for HPV cervical screening, implemented by their National Screening Service.
• Self-sampling will open up different settings for kit distribution and reduce the dependency on clinician taken samples.
• There are many reasons why women do not attend screening appointments, such as: fear of results, fear of test itself, perception that they are not at risk, inability to get appointment, lack of time (young mothers and those unavailable during working hours) and issues with access to care.
• Mobile cervical screening vans which can offer self-sampling were also discussed. In particular, there is a project in Newcastle using mobile screening units which has seemingly been successful in reaching under-screened communities.

HPV-genotyping and Cervical Cytology

• It may be beneficial to utilise more extended genotyping than is currently in use in the UK to stratify risk. HPV genotyping may be particularly helpful for individuals on certain pathways who find themselves in a loop of referrals.

• HPV genotyping may also be useful when the positive predictive value (PPV) of HPV testing drops in vaccinated women.

• Both cytology and HPV-genotyping are valuable. While cytology provides a picture of what’s happening now, HPV-genotyping can indicate what is likely to happen, both now and in the future.

• HPV-genotyping is being used for colposcopy in some settings in England in a focused way, rather than as part of an initial primary test.

• While extending genotyping to include other HPV types (such as 16/18, 31/33/45 and 52/58) would be helpful information gathering to inform management, there is a risk that this may overwhelm colposcopy services.

HPV Vaccination

• So far, not many nations have moved to a one-dose vaccine, but this number is increasing.

• 75% of countries now have vaccination programmes but only 27% of girls have access to vaccination.

• There is growing evidence that vaccination provides little protection to women who are already infected with HPV.

• There is an increasing consensus that vaccinated women can be screened less frequently. Scotland has harder data on this compared to other nations due to the links between screening and vaccination databases.

• In Australia, HPV vaccination is opt-out rather than opt-in. It would be beneficial to explore this further within a UK setting. In particular, whether there are any legal issues around this should be explored.

• Opt-out vaccination would perhaps be easier for pupils in S2 and up, but more difficult for S1 as pupils would need to be 12 years old at the point of vaccination.

• There is an appetite for the sharing of information and good practice between cancer screening groups, which could be explored through the International Papillomavirus Society (IPVS). The Irish programme is at an interesting point in their approach to genotyping and self-sampling and a meeting with the programme management team would allow for sharing of best practice.

Communication and Education

• There was helpful discussion at the conference around reframing the perspective of screening uptake and the language used. It is perhaps more helpful to think about “reaching those for whom screening has failed” rather than allocating responsibility to under-screened individuals.

• Discussions highlighted the importance of more education at school age to explain what HPV is and how it links to cervical screening.

• A noteworthy project took place with school children in Alabama, whereby pupils designed posters for vaccinations and screening with the goal of raising awareness and engagement.

• Celebrity endorsement works in terms of bringing forward diagnosis among the general population. However, it is difficult to overcome celebrities’ reluctance to talk about personal illnesses.

• TikTok is increasingly used as a primary source by young women when searching for information. It is important to have accurate information and positive stories around screening and HPV vaccination for people to find, rather than negative content and misinformation.

New Therapeutic approaches

• Therapeutics are currently being developed by colleagues at Oxford University. While funding has been secured for the next phase, no new information was presented at the IPVC.

• There is little evidence that the use of existing prophylactic vaccines post-colposcopy or, in older women for persistent HPV, reduces the risk of cervical disease recurring. The NOVEL trial which has yet to report will provide important evidence on this.

If anyone is interested in attending the next IPVC it is being held in Bangkok, Thailand 23^rd – 26^th October 2025.