EUCervScreen QA: Updating guidelines for cervical cancer screening

September marks Gynaecologic Cancer Awareness Month, dedicated to raising awareness of the cancers that affect the female reproductive system. There are five main types of gynaecologic cancers, with cervical cancer being among the most frequently occurring  and among the most frequent causes of cancer death. 

The European Commission has established the European Commission Initiative on Cervical Cancer (EC-CvC), which aims to develop evidence-based recommendations for cancer screening and diagnosis as well as a voluntary European Quality Assurance (QA) scheme for cervical cancer care services.

Funded under EU4Health and coordinated by the International Agency for Research on Cancer (IARC) with guidance from the Commission’s Joint Research Centre, the project EUCervScreen QA was tasked with supporting the Initiative on Cervical Cancer. Since the project recently came to an end, HaDEA spoke with project representative Partha Basu to discover more about its findings and results.

What did EUCervScreen QA focus on?

EUCervScreen QA focused on two key objectives: first, we have been developing evidence-based, patient-centred recommendations for cervical cancer screening and the management of screen-positive individuals. These cover the general population, populations vaccinated against the human papillomavirus (HPV) and other priority population groups within organised population-based screening programmes. 

Second, we have been establishing an evidence-based quality assurance (QA) scheme to support the delivery of high-quality and equitable screening, diagnostic assessment and treatment of cervical precancers and cancers across Europe. The project supported the implementation of the 2022 Council Recommendation on cancer screening, with particular emphasis on increasing participation, reducing inequalities and ensuring quality of care across the screening and treatment continuum. Through the European Commission Initiative on Cervical Cancer (EC-CvC), EUCervScreenQA also contributed to the Commission’s commitment to the WHO global strategy for cervical cancer elimination by providing a common European framework for effective and equitable cervical cancer prevention and care.

Now that the project is finished, what have been its main achievements?

Following the methodology developed by the Commission’s Joint Research Centre (JRC) with the use of the GRADE Evidence-to-Decision¹ framework, the project developed recommendations for cervical cancer screening and the management of screen-positive individuals in Europe through a stepwise approach². For the general population, these addressed the choice of primary screening test, ages to start and stop screening, screening intervals, and HPV testing approaches, including HPV DNA and mRNA testing and self-collected samples. We also developed recommendations on invitation strategies to improve screening participation and triage strategies for HPV-positive individuals. In addition, screening recommendations were developed for HPV-vaccinated populations, taking into account the substantially lower underlying risk of cervical cancer and precancer in vaccinated people.

A multidisciplinary European Working Group of 20 experts, including patient representatives, considered the evidence alongside cost-effectiveness, values and preferences, equity, acceptability, feasibility and resource implications to formulate transparent recommendations. These recommendations are accompanied by indicators to support and monitor their implementation and are publicly available through the Commission’s web-hub including the cervical cancer initiative.  

In parallel, the project developed the QA scheme using the new methodology established by the Commission’s Joint Research Centre for all six European QA schemes for cancer screening and care. Version 0.1 of the QA manual covers: 

• operation and certification;
• service requirements;
• quality indicators;
• competence specifications for auditing;
• a glossary and supporting materials.

Materials are being prepared for pre-feasibility testing in accordance with the criteria of the European co-operation for Accreditation.

_1. GRADE _{is an approach used to assess the certainty of evidence and support healthcare decision-making.} 

_{2. The} WHO STEPwise approach _{to risk factor surveillance of non-communicable diseases (NCDs) is a standardised method for collecting, analysing and disseminating data on key NCD risk factors in countries.}

More specifically, how has EUCervScreen QA contributed to Europe’s Beating Cancer Plan?

EUCervScreenQA has translated the Europe’s Beating Cancer Plan ambitions for cancer prevention and early detection into practical guidance and quality standards for cervical cancer screening and care. The project placed particular emphasis on reducing inequalities, including through strategies to improve screening participation and the use of self-sampling to reach under-screened populations. By providing harmonised recommendations, quality assurance requirements and indicators for implementation and monitoring, EUCervSreenQA has supported more consistent, high-quality and equitable cervical cancer prevention across Europe and contributed to the wider WHO goal of eliminating cervical cancer as a public health problem.

Which are the main expected benefits of this initiative?

Activities under the EC-CvC will ensure a high quality of cervical cancer care services, aiming to reduce inequalities in healthcare delivery, improve effectiveness of screening programs, patients’ quality of life and survival. More specifically, the European QA scheme will define common quality and safety standards for cervical cancer care services, to improve health outcomes and reduce differences between countries. 

Are there any particular challenges the project has faced through its implementation?

A major challenge was delivering the project’s broad and ambitious objectives within a three-year timeframe. Each healthcare question required systematic evidence review, assessment using the GRADE Evidence-to-Decision framework and multidisciplinary consensus. This was particularly complex for HPV-vaccinated populations, where comparative modelling evaluated more than 4000 scenarios reflecting different vaccination and epidemiological contexts across Europe. To manage this breadth, healthcare questions were prioritised and topic-specific subgroups worked in parallel, enabling efficient use of expertise while maintaining rigorous and transparent methods.

The implementation of the new methodology for QA scheme development also required substantial preparatory work and training where we were greatly supported by the colleagues from the JRC. Ensuring broad stakeholder input through public consultation was another important challenge, requiring engagement with diverse professional groups, stakeholders and patient representatives to ensure that the QA requirements were clear, understandable and relevant to practice.

How did you ensure that the initiative on cervical cancer was aligned with the other EC initiatives on cancer screening and care?

The project closely collaborated with the other European Commission initiatives on cancer screening and care, including those addressing breast, colorectal and gastric cancers overall coordinated by the JRC, which followed our project very closely and were always available for any question that came up. Chairs and coordination teams met regularly to harmonise methodologies, share experience and address common challenges, while first transversal working groups facilitated collaboration on areas relevant across cancer types. This helped not only to ensure methodological consistency, but also to streamline aspects common to all initiatives, while supporting shared European objectives around equity, quality of care, person-centred services and cancer burden reduction.

How relevant is the support of EU funding for this kind of initiative?

EU funding is fundamental to an initiative of this scale, allowing us to address a shared European challenge through shared European solutions. EU4Health funding has enabled us to bring together multidisciplinary expertise from across Europe, undertake rigorous evidence synthesis and modelling, and translate the evidence into recommendations and a complementary quality assurance scheme. This European collaboration reduces duplication of effort, creates common standards and supports countries in implementing high-quality and equitable cervical cancer prevention. Sustained EU support will also be important for keeping recommendations and QA requirements up to date as evidence and technologies continue to evolve.

Relevant links

EC-CvC at a glance

Background 

EU4Health is the fourth and largest of the EU health programmes. The EU4Health programme goes beyond an ambitious response to the COVID-19 crisis to address the resilience of European healthcare systems. The programme provides funding to national authorities, health organisations and other bodies through grants and public procurement, contributing to a healthier Europe. 

HaDEA manages the vast majority of the total EU4Health budget and implements the programme by managing calls for proposals and tenders from 2021 to 2027.