This paper summarises the position of ESGO and EFC on cervical screening based on existing guidelines and opinions of a team of lead experts. HPV test is replacing cytology as this offers greater protection against cervical cancer and allows longer screening intervals. Only a dozen of HPV tests are considered as clinically validated for screening. The lower specificity of HPV test dictates the use of triage tests that can select women for colposcopy. Reflex cytology is currently the only well validated triage test; HPV genotyping and p16 immunostaining may be used in the future, although methylation assays and viral load also look promising. A summary of quality assurance benchmarks is provided, and the importance to audit the screening histories of women who developed cancer is noted as a key objective. HPV-based screening is more cost-effective than cytology or cotesting. HPV-based screening should continue in the post-vaccination era. Only a fraction of the female population is vaccinated, and this varies across countries. A major challenge will be to personalise screening frequency according to vaccination status. Still the most important factor for successful prevention by screening is high population coverage and organised screening. Screening with self-sampling to reach under-screened women is promising.

The two Brewer spectrophotometers of the Finnish Meteorological Institute at Jokioinen and Sodankyla have been operated according to the highest levels of the WMO/GAW (World Meteorological Organization/Global Atmosphere Watch) recommendations with rigorous quality control and quality assurance. The calibration of the instruments is based on annual recalibrations of primary standard lamps in the VTT MIKES Metrology National Standards Laboratory in Finland and an exhaustive measurement program with measurements of standard and working lamps in the on-site optical laboratories. Over the years, the maintenance of the calibration has produced data sets of approximately 2000 lamp scans for both instruments. An extensive re-examination of the lamp measurements and the response of the spectrophotometers was carried out. The primary standard lamps were found to age on an average rate of 0.3% per burn. The responsivity at wavelength 311 nm was found to exhibit both long-term and short-term changes. The overall long-term change was declining. In addition, abrupt changes of as large as 25% were detected. The short-term changes were found to fluctuate on time frames shorter than the interval between the measurements of the primary standard lamps. This underlines the importance of the use of more frequently measured working standard lamps.

The age-standardised incidence of cervical cancer in Europe varies widely by country (between 3 and 25/100000 women-years) in 2018. Human papillomavirus (HPV) vaccine coverage is low in countries with the highest incidence and screening performance is heterogeneous among European countries. A broad group of delegates of scientific professional societies and cancer organisations endorse the principles of the WHO call to eliminate cervical cancer as a public health problem, also in Europe. All European nations should, by 2030, reach at least 90% HPV vaccine coverage among girls by the age of 15 years and also boys, if cost-effective; they should introduce organised population-based HPV-based screening and achieve 70% of screening coverage in the target age group, providing also HPV testing on self-samples for nonscreened or underscreened women; and to manage 90% of screen-positive women. To guide member states, a group of scientific professional societies and cancer organisations engage to assist in the rollout of a series of concerted evidence-based actions. European health authorities are requested to mandate a group of experts to develop the third edition of European Guidelines for Quality Assurance of Cervical Cancer prevention based on integrated HPV vaccination and screening and to monitor the progress towards the elimination goal. The occurrence of the COVID-19 pandemic, having interrupted prevention activities temporarily, should not deviate stakeholders from this ambition. In the immediate postepidemic phase, health professionals should focus on high-risk women and adhere to cost-effective policies including self-sampling.