Illustration of the HPV collective now campaigning for organized screening for cervical cancer to favor the HPV test, which is more reliable than a smear. - O. Gabriel / 20 Minutes

  • Cervical cancer is linked to the papillomavirus, which in a minority of cases causes cancerous lesions.
  • To fight against this cancer, which causes 1,000 deaths per year, organized screening was launched in 2018. But the recommendations evolved in 2019, prioritizing the HPV test ... which is still not reimbursed.
  • The French Society of Colposcopy and Cervico-Vaginal Pathology wishes to put pressure on things to move forward faster.

Since 2018, France has launched an organized cervical cancer screening program. But the first invitations to perform a gynecological examination should not arrive in mailboxes until the beginning of 2020. Why this delay?

Why organized screening?

After breast and colorectal cancer, cervical cancer is the third to benefit from systematic screening. Why ? This fairly rare cancer, with 3,000 cases per year, but 1,000 deaths, is preventable. Linked to the HPV virus, it can be detected early, thanks to the smear, a gynecological examination that all women are invited to do every three years, when they are followed by a gynecologist. Except that 40% of French women do not follow these recommendations. This is why France decided in 2018 to invite all women to make a smear, between 25 and 65 years old, by individual mail.

"The real challenge is to make the population adhere to screening and to properly care for these women," specifies Christine Bergeron, vice-president of the French Society of Colposcopia and Cervico-Vaginal Pathology (SFCPCV). With the HPV test, we hope to reach women who are not followed by a gynecologist, ”recalling that this test can be done by self-sampling. "It must be understood that this screening is used to diagnose lesions to avoid cancer," introduced Xavier Carcopino, secretary in charge of national affairs at the SFCPCV. Women tell us, I feel great, I don't need to do a smear. But these lesions are asymptomatic. "

Is the smear finished?

But since 2018, few women have received these invitations to consult ... It must be said that in the meantime, the recommendations have evolved. Since July 2019, the French National Authority for Health has requested that the HPV test be used as a first line in women between 30 and 65 years of age, in whom it is more effective than cytological examination. "The smear is not over, it's rather that it no longer has the same place", summarizes Christine Bergeron. Indeed, this more reliable HPV test allows a first sorting, then, if it is positive, pass through the smear, from the same sample. If this smear is abnormal in turn, the patient will have to undergo a colposcopy.

On the other hand, for women from 25 to 30, it is always the smear that is indicated. Why ? "What matters is that they are screened whatever the test! insists the secretary of the SFCPCV. The problem is that between 25 and 30 years old, there are a lot of transient infections. »Which will not progress to pre-cancerous lesions and will disappear without treatment. If the HPV test were indicated, many of these young women would risk worrying without reason, or even performing unnecessary tests and treatments. Because you have to keep in mind that around 80% of men and women will one day be infected with this papillomavirus ... without any signs or consequences.

Out of date invitations

Where are we now? After decades of smear testing, doctors need to adopt this new test and explain it to their patients. and that the regional centers, which pilot this cancer screening, update themselves. "For Ile-de-France, the invitations left in December, with an invitation to make a smear for women over 60, because they are more likely to be lost to follow", specifies Christine Bergeron. Indeed, once the pregnancies are over, menopause is established, many women no longer consult gynecologists and therefore risk going under the radar of prevention. But why do these letters recommend a smear rather than an HPV test? "The HAS made the announcement in July 2019, but the organizations that manage the screening are still based on the smear," recognizes Xavier Carcopino. And for the moment each regional center manages this screening as it sees fit. But if the SFCPCV is to be believed, this modification could be accelerated. Indeed, in the coming weeks, a possible publication in the Official Journal could force all regions to recommend the HPV test rather than the smear.

A recommended test, but not reimbursed

If this gradual transition is not necessarily abnormal, these gynecologists alert on a size brake: for the moment the HPV test is not reimbursed. However, in its recommendations, the HAS asked for “an evolution in the codification of the screening procedure and full coverage by health insurance, without advance payment, for the performance of the HPV test every 5 years in women aged 30 to 65 ”. "The transition is always long, but it is problematic," confirms Xavier Carcopino. Currently, gynecologists explain that the best test is the HPV test, but that you have to pay between 30 and 40 euros to get it. The administrative machinery and the lack of anticipation mean that we find ourselves in a somewhat complicated situation ... ”This creates confusion among patients. Already that abandoning the smear to replace it with the HPV test is not easy to integrate, if the latter is not reimbursed, women will find it difficult to adopt it. "Basically, those who have the means can have a more effective test, and we are moving towards two-speed medicine," says Xavier Carcopino.

A financial brake all the more problematic since the most precarious women, often far from care, will not be able to get this paid test. Bernard Huynh, treasurer of the SFCPCV reminds all the same that the health law 2020 has set up a high council of classifications to avoid this kind of discrepancy. "This high council will start working in April 2020 and we recommend that this subject be a priority for this new body", he says.

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