The introduction of hpv tests can save lives - but only 13 out of 21 regions follow the recommendations

Sweden has had a national screening program against cervical cancer, with regular gynecological cell test checks, since the 1960s. It has contributed to a sharp reduction in cancer cases, but something has happened in recent years.

More women are now suffering from cervical cancer in Sweden than before. Since 2014, the number of people with illness has increased dramatically - with about 100 cases - and the increase has mainly occurred among women who have been told that their cell tests are normal. It shows a report from the National Quality Register for Cervical Cancer Prevention, from earlier this year.

Since 2015, the National Board of Health and Welfare recommends that women who are 30 years and older should be tested primarily for human papillomavirus, hpv, in their gynecological cell test.

HPV is the world's most commonly sexually transmitted virus and a majority of the population gets HPV at some point in life. The virus, which often heals itself, is found in over 100 variants, most of which are harmless. But at least 14 virus types can cause cell changes that can then lead to cancer.

A gynecological cell sample is taken from the lower part of the cervix, which is called the uterus and which opens into the vagina. Previously, in a first study, they looked for cell changes, but by testing whether the cell sample gives rise to HPV infection, it is early possible to detect more women at risk of developing cervical cancer. This is called primary hpv analysis.

- It is a more sensitive test and when it has been introduced throughout the country, it is estimated that it will save 30 more lives and lead to 60 fewer cancer cases per year. It captures more women with cancer precursors - cell tests miss some, says Lena Silfverdal, chief physician and coordinator of the national working group for the cervical cancer screening program.

Thus, with the new recommendations, a new group of women, those with residual hpv without cell changes, are investigated. They have not previously been found or investigated. If a woman is over 30 and tested positive for hpv, the sample is examined with a microscope to see if there are cell changes. If no cell changes are found, the woman is called again after 1.5-3 years to see if hpv remains.

"You should not release women until the virus has healed," says Lena Silfverdal.

She is critical that it has taken so long to introduce the new routines. Four years have passed since the National Board of Health and Welfare issued new guidelines. Although only 13 out of 21 regions follow the recommendations, a survey by SVT Nyheter sent out to all regions.

- It's sad, but there are reasons for it. Updating IT systems has proved to be very complicated and very time and resource consuming.

Each region must develop its own technical solutions for call systems and this entails major organizational changes.

"The consequence is that you will become worse at preventing cervical cancer where you have not introduced primary hpv analysis of cell samples," says Pär Sparén, professor at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet.

He, together with colleagues in the national quality register, has investigated the increase in cancer cases and believes that the development speaks even more strongly to the introduction of the new recommendations.

- We do not know exactly why, but it seems that the sensitivity in the analysis of cell samples has deteriorated in some laboratories. More samples were considered normal which were not normal. The best way to address this problem is to introduce primary hpv analyzes throughout the country.