ESGO/ENGAGe Position · 2026 · Based on RISCC Horizon 2020

Risk-Based Cervical Cancer Screening — ESGO/ENGAGe Position

European Society of Gynaecological Oncology / ENGAGe Position on risk-based cervical cancer screening
HPV primary replaces cytology · gender-neutral vaccination · genotyping individualizes risk · methylation cuts colposcopy referrals (FAM19A4/miR124-2 −86%)
Joura E, Chatzistamatiou K, Gultekin M, Sehouli J, Toth I, Toth R — on behalf of ESGO
RISCC Consortium · Horizon 2020 (2020–2024) · 11 partners · CoheaHr cohort >150,000 women
HPV 1st
replaces cytology (60–70% ↑ protection)
Neutral
gender-neutral vaccination
Genotype
individualized risk (OR 5.8 HPV16)
−86%
colposcopy referrals by methylation

1Background & RISCC Project

  • RISCC: 4-yr Horizon 2020 consortium — develop & validate risk-stratified screening; ESGO/ENGAGe among 11 partners.
  • Driver: WHO 90-70-90 pillars; one-size-fits-all rarely works — fine-tuning needed.
  • Evidence base: CoheaHr cohort >150,000 women; vaccination-rate risk models; e-health platforms.

2Evidence & Method

60–70%
greater protection vs cytology
OR 5.8
HPV16 risk persistence
OR 3.4
other hrHPV persistence
  • HPV vs cytology: randomized trials show 60–70% greater protection against invasive cancer; mRNA similar sensitivity, slightly better specificity.
  • Lower specificity (Cochrane) → triage of HPV(+) is a necessary step.
  • Genotyping: 2 consecutive hrHPV+ raises CIN3 risk, esp. HPV16.
  • Method: ESGO SOP working group; unanimous approval.
HPV16 persistence
OR 5.8
Other hrHPV persistence
OR 3.4
DNA
primary test
mRNA
similar Se · better Sp
validated
quality indicators
  • Organized programs: use highly accurate, clinically validated tests meeting quality indicators.
  • Targeted intensity: intense for high-risk, lighter for low-risk — cost-effective budgeting.
  • Self-sampling: PCR-based tests only; validate for clinician samples first; similar Se/Sp.
  • Vaccine economics: gender-neutral cost-effective when coverage suboptimal; girls-only better once WHO targets met.
  • Risk models: vaccination-coverage-dependent risk profiles for (pre)cancer.
  • Digital: mobile/e-health platforms to recruit & educate women and providers.
Risk parameters: HPV genotype + age + screening history + vaccination status; targeted screening intensity by risk stratum.

3Six Core Positions

1
HPV DNA primary — replace cytology & co-testing; clinically validated tests.
2
Gender-neutral vaccination — accelerate herd immunity when coverage suboptimal.
3
HPV genotyping + age + history — individualized risk assessment.
4
Methylation triage — molecular approach, fewer colposcopy referrals.
5
Vaccinated cohorts — longer intervals · conservative HSIL management · genotyping substitution.
6
Self-sampling + PCR-HPV — safe, effective; flexible access pathways.

4Methylation — Colposcopy Referral Reduction

FAM19A4/miR124-2 · direct
−86%
ASCL1/LHX8 · direct
−71%
FAM19A4/miR124-2 · 1yr
−42%
ASCL1/LHX8 · 1yr
−36%
  • Fully molecular pathway: methylation triage basis for sensitive, automated patient triage.

5Implementation Call

90%
vaccination
70%
screening
90%
treatment
6
core positions
3
WHO pillars
150k+
CoheaHr cohort
  • Registry value: link invitation, screening, HPV, pathology & vaccination to optimize as immunity evolves.
  • Budget reallocation: redirect funds from low-risk screening to high-need sectors.
  • Reform: risk-stratified, patient-centered strategies in European programs.
  • Infrastructure: integrated population registries · standardized quality indicators.
  • Monitoring: real-time surveillance of participation, vaccination & outcomes.
  • Access: multiple self-sampling pathways (onsite / by mail) for under-screened groups.
  • Linked data: screening · HPV · histopathology · vaccination · invitation histories — identify gaps & adapt.
Clinical Significance