Guidelines for cervical cancer screening in South Africa

Abstract

Cervical cancer, caused by persistent cervical infection by high-risk HPV and made worse by the HIV epidemic, remains an important cause of morbidity and mortality in South Africa. The SA HPV Advisory Board previously recommended HPV-based primary screening, and now international support for this approach is also mounting in view of higher sensitivity. The main advantages for South Africa are the ability to safely increase screening interval and to test cervico-vaginal self-sampled specimens. Non-discriminatory HPV tests give a “negative” or “positive” answer for the presence of any high-risk HPV. Discriminatory tests differentiate between the highest risk types and “other” high-risk types and results are more specific. Triage or secondary tests are important for patients with a medium risk for a current or future lesion, while those with a higher risk can be treated without triage. In view of differences in health care systems, several options for screening, triage and treatment are provided. These options still include cytology screening, which the Board recommends should be chased out. Affordability to the health care system, cervical cancer risk and therefore HIV status influences screening entry and exit ages which is generally recommended from 25 to 65 years. The management of positive screening tests and treatment of women with lesions or risk is an essential part of prevention. Two algorithms are provided to simplify triage, treatment and follow-up decisions, namely for cytology- and HPV-based screening.