IARC 60th Anniversary - 19-21 May 2026
Session : Translating Evidence into Action for Cervical Cancer Elimination: HPV Vaccination and HPV-Based Screening
Developing evidence-based triage recommendations for HPV-Positive individuals in Europe: progress from the European Initiative on Cervical Cancer
RAMIREZ A. 1, GIORGI ROSSI P. 2, TAGHAVI K. 1, RUSSELL N. 3, HILLEMANNS P. 4, WENTZENSEN N. 5, VEERUS P. 6, ARMAROLI P. 7, IVANUš U. 8, BHATLA N. 9, QASEEM A. 10, BROUTET N. 11, BASU P. 1, ARBYN M. 1,12,13
1 International Agency for Research on Cancer, Lyon, France; 2 Epidemiology Unit, AUSL - IRCCS di Reggio Emilia, Reggio Emilia, Italy; 3 Department of Obstetrics and Gynaecology, University College Cork, College Road, Cork, Ireland; 4 Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover, Germany; 5 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States; 6 Department of Epidemiology and Biostatistics at the National Institute for Health Development in Tallinn, Tallin, Estonia; 7 Cancer Epidemiology Unit and Centre for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy; 8 Department of Cervical Cancer Screening, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia; 9 Department of Preventive Oncology, National Cancer Institute, AIIMS , Delhi, India; 10 American College of Physicians, Philadelphia, Pennsylvania, United States; 11 Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; 12 Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium; 13 Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
Background
The European Commission Initiative on Cervical Cancer (EC-CvC) is a coordinated pan-European effort to reduce inequities in cervical cancer burden. As part of this initiative, the European Guidelines for Cervical Cancer Prevention are being updated. The HPV detection test is strongly recommended over cytology for primary screening.1 Whereas, the HPV test is more sensitive than cytology for detecting precancerous lesions and cervical cancer, it is less specific, making the optimal management of HPV-positive individuals a critical challenge and highlighting the need for accurate triage tests.2 The development of evidence-based triage recommendations is needed to minimise the burden of follow-up and to avoid over-diagnosis and over-treatment. We aimed to report the progress made in developing triage recommendations.
Methods
Eighteen multidisciplinary working group experts prioritised the triage tests to be evaluated using a PICO (population, intervention, comparison, outcome) framework. A smaller sub-group refined the research questions, will draft recommendations and guide the full working group to finalise them. An independent systematic review team (Sciensano) is conducting systematic reviews that will support the evidence assessment following the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, which evaluates the certainty of evidence and strength of recommendations, and considers values, preferences, and practical implementation. Discussions are also ongoing regarding risk-based management strategies, which emphasise equal management for equal risk of cervical cancer.
Results
Six PICO questions were developed to assess triage strategies for HPV-positive women in Europe, focusing on triage tests that could improve the prediction of CIN3+ risk compared with cytology at the cut-off of ASC-US+. These questions address the potential use of cytology at higher cut-offs (LSIL+, ASC-H+, HSIL+), HPV genotyping (limited and extended), the combination of HPV genotyping and cytology, p16/Ki-67 dual staining, the combination of genotyping and p16/Ki-67, and methylation assays.
The synthesis of evidence is ongoing, and the findings will support the development of first triage recommendations for the EC-CvC within the EC-CvC.
Conclusion
The updated EC-CvC guidelines will provide evidence-based recommendations to triage HPV-positive individuals in cervical cancer screening programmes. The identification of triage strategies that balance sensitivity and specificity combined with the integration of risk-based approaches, will support the optimisation of the management of HPV-positive individuals. This will ultimately reduce the risks of overdiagnosis and overtreatment and ensure that those individuals, who will benefit of most from further assessment, get timely access to this and will contribute to a reduction in the burden of cervical cancer in Europe.
References
1. European Commission. European guidelines on cervical cancer screening and diagnosis. Accessed 10 October 2025. https://cancer-screening-and-care.jrc.ec.europa.eu/en/ec-cvc/european-cervical-cancer-guidelines?topic=328&usertype=327
2. Arbyn M, Ronco G, Anttila A, et al. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine. Nov 2012;30 Suppl 5:F88-99. doi:10.1016/j.vaccine.2012.06.095