Detect and prevent precancerous lesions

A national screening program started in France in 2018 (www.e-cancer.fr and www.has-sante.fr).
Its objective is to reduce the incidence and the number of deaths by 30% in 10 years. It concerns women between the ages of 25 and 65.
Women who have not had a screening test for more than 3 years are invited to take a test. The result is sent to the woman, the sampler, the attending physician and the regional coordination centre. In the event of an unsatisfactory or abnormal sample, the prescriber must inform the woman.

Organized screening has long been based on performing cervical-vaginal smears.
This test is carried out in consultation. It consists of removing cells by simply rubbing a spatula or brush on the cervix. The sample is spread on a glass slide and fixed then sent to the laboratory.
Pap smears can detect pre-cancerous lesions.



Its result must be expressed according to the classification of BETHESDA. This formulation is a common, international language between cytologists and clinicians. It makes it possible to say without ambiguity the type of anomaly observed and therefore to trigger the appropriate care.

A new test made its appearance in the screening organized in May 2020: the HPV test.

This sample is also taken during a gynecological consultation or as a self-test.
A swab is passed through the cervix and the presence of HPV is tested by molecular biology.
This test detects HPV infections, but does not diagnose lesions on the cervix.
Its interest lies in the fact that in the absence of high-risk HPV infection, the risk of developing a pre-cancerous lesion or cancer is extremely low. In the event of a negative test, it is not renewed until 5 years later.

The recommendations of organized screening are now to do
- a smear screening from 25 to 29 years old
   o one test every 3 years after 2 normal tests one year apart
   o because HPV infections are frequent at this age and often without consequences. Finding an HPV infection would frequently lead to unnecessary examinations or procedures.

- Screening by HPV test after the age of 30.
   o The first test is to be performed 3 years after the last smear
   o The HPV test is repeated every 5 years thereafter

It is also possible to do a screening smear or an HPV test outside the organized screening, but this will then be chargeable.