Cervical cancer in Norway and Sweden: Current affairs in prevention efforts
On March 3rd, the Department of Health Management and Health Economics hosted a seminar entitled ‘Cervical cancer in Norway and Sweden: Current affairs in prevention efforts’. There were more than 40 participants from Norway and Sweden, and speakers from Karolinska Institutet, Harvard University, the Cancer Registry of Norway, and the University of Oslo.
Illustration from wikipedia: Histopathologic image (H&E stain) of carcinoma in situ (also called CIN III), stage 0:
Dr. Pär Sparén, Professor of Medical Epidemiology at Karolinska Institutet, presented the ongoing ACCES project: ‘Advancing Cervical Cancer Eradication Strategies’. The ACCES is aimed at evaluating current cervical cancer preventive strategies using comprehensive registry data and mathematical simulation models. One of the ACCES projects is to evaluate the safety and effectiveness of HPV vaccination. Screening uptake for the first vaccinated cohort has been evaluated. – We did not see a reduction in screening uptake among vaccinated women. If anything, we saw the reverse, Pär Sparén said in his talk.
Screening participation has also been the focus of current affairs in cervical cancer research in Norway. Kine Pedersen, PhD student at the University of Oslo, talked about compliance to screening guidelines in Norway over multiple screening rounds. – Only approximately 50% consistently get at least one screen every 3.5 years, and the majority of these are screening more frequently than recommended. However, these women are observed to have a lower risk of developing cervical cancer than women who seldom or never attend screening.
The Norwegian Cervical Cancer Screening Program is managed by the Cancer Registry of Norway. – At the Cancer Registry, we are undertaking a wide range of research on HPV-related disease, including biological mechanisms, life style factors and preventative policies, Dr. Mari Nygård said, leader of the HPV research group at the Cancer Registry of Norway. One of their ongoing projects related to screening participation involves social nudging and gamification of health information. – By informing people about HPV and cervical cancer through games, the aim is to improve screening participation rates, Dr. Nygård said.
Another ongoing effort to improve screening compliance is represented by HPV-based self-sampling. – HPV self-sampling of non-compliers may improve the effectiveness of screening, and is likely to represent ‘good value for money’, Dr. Emily Burger said, Postdoctoral fellow at Harvard University and University of Oslo, but underlined that the value of self-sampling is contingent on understanding the screening history of respondents.
Dr. Ameli Tropé, leader of the Norwegian Cervical Cancer Screening Program, talked about the current and future cervical cancer prevention in Norway. – An important challenge is that we don’t have access to individual screening history, which is crucial for improving follow-up of women with abnormal screening results. Dr. Tropé ended her talk by envisioning the future of cervical cancer screening in Norway. – The Norwegian screening program is in transition; with new biomarkers and as vaccinated women enter screening target age, future screening policies will rely on risk-based algorithms.