COHEAHR
Background
Cervical cancer is an important health problem in Europe with about 60,000 new cases per year and 25,000 new deaths per year. The burden of cervical cancer varies considerably across Europe and is especially high in Central and Eastern European countries.
The variation in cervical cancer incidence can largely be ascribed to differences in cancer control programmes, which vary with respect to screening intervals, targeted age groups, quality of screening, coordination (organized or opportunistic) and coverage of the programme.
Apart from cytology-based screening, new methods for cervical cancer prevention have become available in recent years, including screening tests to detect HPV infection. The higher sensitivity and negative predictive value for detection of precancerous lesions allows for extended screening intervals. However, its lower specificity requires of further data on long-term follow-up and triage methods of HPV positive women to reduce the number of referrals for further gynaecologic examination.
An important aspect of a successful screening program is a high participation rate since most cervical cancer cases are observed in poorly screened and unscreened women. Self-sampling by the participant women have been proposed as a friendly and acceptable alternative to sampling by the physician in order to reach marginalized/poorly screened populations.
Since 2008, many countries have introduced HPV vaccination in routine immunization programmes for girls with target ages between 10-14 years. In the initial years, catch-up vaccination of older girls within the range of 15-26 years were also provided. Therefore, the first vaccinated cohorts are reaching screening ages and screening programmes will need to adapt in order to remain cost-effective.
Recent evidence shows that a 2-dose regimen provides similar protection as a 3-dose regimen, and the use of a single dose is currently being explored. Additional populations that can benefit from vaccination include men and adult women. Males vaccination offers direct beneficial effects on their HPV-related burden (for example anal cancer, or head-and-neck cancers), and indirect effects on cervical cancer by reducing the HPV prevalence in the general population. Female adult vaccination could reduce the acquisition of HPV infections, thus allowing the use of longer screening intervals and offering novel prevention strategies to countries where high-quality regular screening is difficult to achieve.
Therefore, integrated prevention strategies of vaccination and screening need to be developed. However, optimal prevention policies, integrating both vaccination and screening, will likely differ between countries because of substantial variation in health care resources and in the burden of cervical cancer.
The CoheaHr project (COmparing HEAlth services interventions for the prevention of HPV-Related cancer) is a European-funded multidisciplinary consortium of key researchers in the field of HPV screening and vaccination conducted between 2014 and 2018. It used Comparative effectiveness research (CER)1, to compare different health interventions in country-specific settings, in order to:
- provide a strong evidence base to enable policy and decision makers as well as other stakeholders to make informed decisions on HPV prevention strategies,
- contribute to strengthening health systems and health services interventions in Europe,
- improve health care at both the individual and population levels.
(1) "The generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care” (Institute of Medicine, Washington, DC, USA, 2009).
This project has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no FP7-F3-2013-603019.