title: The future role for colposcopy in Europe.
abstract: Improvements in the performance of cervical screening may be limited by the diagnostic performance of colposcopy. Nonetheless, colposcopy remains the best available tool to assess women considered at high risk for having or developing cervical cancer. The provision and role of colposcopy across Europe is variable. Introduction of vaccination against human papillomavirus (HPV) types 16 and 18 as well as the possible switch to HPV-based screening is likely to change the profiles of women presenting to colposcopy services and provide management difficulties for the colposcopist.The standard of colposcopy in Europe can be maintained or improved despite a variable availability of screening. The prevalence of cervical intraepithelial neoplasia grade 3 may decrease for women having had HPV vaccination. The incidence of cervical intraepithelial neoplasia grade 3 and cervical cancer in second and subsequent rounds of HPV-based screening are likely to decrease compared to cytology-based screening. In HPV-based screening, the numbers of women with no detectable or minor abnormalities at colposcopy and with screen-detected glandular disease are likely to increase. We have considered how these issues will affect states that have varying implementation of organized cervical screening programs and varying degrees of implementation of HPV testing or vaccination.The development of quality assurance across Europe accompanying these program changes is discussed.
authors.affiliation: 1Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK; 2Department of Gynecology, National Screening Center, Tbilisi, Georgia; 3Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium; 4Laboratoire Cerba, Paris, France; 5Department of Gynecology and Obstetrics, University of Bari, Bari, Italy; 6Hôpital Tenon, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Paris, France; 7Department of Obstetrics and Gynecology, Helsinki University Hospital, Finland; 8The Beacon Hospital, Sandyford, Dublin, Ireland; 9Department of Obstetrics and Gynaecology, University Hospital of North Staffordshire, Stoke-on-Trent, UK; 10D-18437 Stralsund, Grünthal, Germany; and 11Department of Obstetrics and Gynaecology, Klinikum Wolfsburg, Wolfsburg, Germany.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Leeson
authors.forename: Tamar
authors.initials: T
authors.lastname: Alibegashvili
authors.forename: Marc
authors.initials: M
authors.lastname: Arbyn
authors.forename: Christine
authors.initials: C
authors.lastname: Bergeron
authors.forename: Carmine
authors.initials: C
authors.lastname: Carriero
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Mergui
authors.forename: Pekka
authors.initials: P
authors.lastname: Nieminen
authors.forename: Walter
authors.initials: W
authors.lastname: Prendiville
authors.forename: Charles W E
authors.initials: CW
authors.lastname: Redman
authors.forename: Gudrun C
authors.initials: GC
authors.lastname: Rieck
authors.forename: Jens
authors.initials: J
authors.lastname: Quaas
authors.forename: K Ulrich
authors.initials: KU
authors.lastname: Petry
mesh_terms: D003127:Colposcopy / Q000706:statistics & numerical data* / Q000639:trends*; D055088:Early Detection of Cancer / Q000379:methods* / Q000639:trends*; D005060:Europe; D005260:Female; D006801:Humans; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*