In France, cervical cancer screening is aimed at all asymptomatic women aged 25 to 65, in accordance with the directives of the High Authority of Health (HAS).
1. Cervical cancer: Start of screening at age 25
Public health France highlights several elements justifying the start of screening from the age of 25. First of all, she emphasizes that human papillomavirus (HPV) infection, although common in young women, is generally transient, with 90% of detected infections disappearing naturally within two years. In addition, it specifies that only a small proportion of HPV infections, notably types 16 and 18, present a risk of progression to invasive cancer. Additionally, cervical cancer progresses slowly, usually requiring between 10 and 20 years to progress from precancerous to invasive cancer.
Since May 2018, cervical cancer screening (CCU) has been based on a national organized screening program (PNDO), aimed at all women aged 25 to 65. Women who have not been screened at the recommended frequency receive an invitation from the regional cancer screening coordination center, with screening reimbursed at 100%. Screening methods now vary depending on the age of the women. For those aged 25 to 29, the previous methods are maintained: a screening test is carried out by cytological examination every 3 years, after two first tests carried out 1 year apart, with normal results.
2. Frequency of smears between 30 and 65 years
As for women aged 30 to 65, the HAS recently adjusted the screening methods, updating its 2010 recommendations. It now recommends that the HPV test, more effective for this age group, replace the cytological examination. . This test is carried out 3 years after the last cytological examination, the result of which was normal. Thereafter, a new test is carried out every 5 years until the age of 65, provided the test result is negative. This HPV test is reimbursed at 70% by Health Insurance, outside of the PNDO.
3. Stopping screening at age 65
The HAS also recommends stopping cervical cancer screening at the age of 65, motivated by two main reasons. On the one hand, she emphasizes that after age 65, the risk of developing cervical cancer decreases considerably. On the other hand, it highlights the benefit/risk imbalance of screening, which becomes unfavorable at this age. However, this recommendation is conditional on normal/negative results in the two previous screening tests. However, a screening test may be considered for women over 65 in certain specific situations, such as the inability to verify the normality of the last two screenings or the absence of regular gynecological follow-up with absence of samples in the three years preceding the end of screening age.
Sources
- Cervical cancer screening: the HPV test recommended for women over 30, Public Health France, July 10, 2020
- Cervical cancer screening: the HPV-HR test recommended for women over 30, HAS, July 6, 2020
- Why 25 to 65 years old?, National Cancer Institute, January 20, 2023