The Catalan pharmacies will dispense free, to women between 30 and 65 years, ‘kits’ of self-diagnosis of the human papilloma virus (HPV), sexually transmitted infection that affects both men and women and that, specifically in the female group, carries the risk of ending up generating a cervical cancer. The Department of Health has launched a pilot test in pharmacies of El Prat de Llobregat, Begues, Botigues de Sitges, Castelldefels, Gavà, Sant Climent de Llobregat and Viladecans. The department anticipates consolidate this initiative, piloted since last year by the Catalan Institute of Oncology (ICO), throughout this 2023 and expand it to other areas of the territory in 2024. In the last year, some 2,500 women from Baix Llobregat they were invited to participate in this test and 1,028 collected the ‘kit’. Of these, 948 took the test on their own and delivered it to the pharmacy, which in turn sent it to the ICO.
In Catalonia, the cervical cancer screening, which is part of a early detection program through Pap smears which, every three years, is practiced on the women between the ages of 25 and 65 in primary care centers (CAP). The Department of Health, that since this school year it already vaccinates both girls and boys in sixth grade (12 years old) against the papilloma virus, it is now available to redouble prevention and supply these products free of charge in pharmacies self-sample kits to detect the papilloma virus. The HPV test has advantages over cytology that it is more effective in detecting this virus and can be done at home. It is something very similar to what already happens with the screenings of colon cancer: Catalan pharmacies dispense ‘kits’ to find hidden blood in stool and thus detect precociously this disease in people who have previously received a letter from your health center.
Within Spain, Catalonia is pioneer at the time of setting screenings of this type and also to include pharmacies within the sanitary system, thus improving the epidemiological surveillance and public health. It demonstrated it recently, during the pandemic, when it was one of the 12 communities that enabled an entire network of pharmacies to do covid tests, which made rapid detection of the virus available to the population, which helped to contain saturation of primary care. Now Catalonia is the first autonomy to incorporate these HPV self-sample ‘kits’ in pharmacies (Only Murcia started a pilot this February for women to take these tests at home and later deliver them to their health center).
This human papilloma virus test (HPV) has more detectability (of this virus) than Pap smears. Thats why he cervical cancer early detection program de Salut is in full transition to ensure that the HPV test is done before Pap smears. Currently, any woman who goes to the CAP to have an HPV test is given a cytology. “The idea is to gradually go on to do HPV test first and, if it is positive, make a cytology”, Explain Laia Bruni, head of unit at ICO, where she coordinates the program for the early detection of cervical cancer.
Cytology is useful to see if there is altered cells. “Are different tests. The HPV test detects the human papilloma virus. Cytology tells us if there is precancerous lesion. If it exists, we remove the lesion and it is shown that, by doing so, the possibility of developing cervical cancer is eliminated,” adds Bruni.
Being positive for HPV is not synonymous with ending up developing cancer. There is many women who test positive that They do not have any precancerous lesion. In fact, gynecologists advise against doing this test in under 30 years. “Human papilloma infection is highly prevalent in sexually active young women. Probably 80% or 90% of women, by the time they are 50 years old, will have been positive at some point”, points Damian Dexeus, the director of the Women’s gynecological clinic.
However, cervical cancer It is very rare in women under 30 years of age. “It doesn’t make sense to test this group, but to do it in older than 30 years will make us gain efficiency”, adds Dexeus, who values the Salut measure very positively. The women of more “30 or 35 years” they are less likely to shed the virus spontaneously and therefore more at risk of developing the disease.
Inclusion of more women
According to this gynecologist, doing an HPV self-test will be “very useful” for all those women who are left out of the system. “It’s an attempt to reduce that relatively stable group that continues to elude us because they have not gone to the system. They tend to be vulnerable women. The mere fact of having just one check-up in your life already reduces the risk of developing cervical cancer,” says Dexeus. Clinical trials have shown the effectiveness to do the human papilloma virus test both at home and in the health center.
In the pilot test that Salut and the ICO are developing in Baix Llobregat, coordinated by the sexual and reproductive health care unit (ASSIR) of Gavà, to women who make an appointment to get one cytology the doctors offer them to do a self-sample for HPV. These users are referred to the ICO, which sends them an SMS informing them that they can go to the pharmacy to pick up the self-sample ‘kit’.
The pharmacies return these collected self-samples to the ICO. The ICO analyzes them. The users who give positive are once again referred to ASSIR for cytology and to those who are negative they go back to review in five years. “The second phase of this pilot test will be extend the test to all women regardless whether or not they have requested the ASSIR test. This will allow us to organize the entire system before opening it to the entire population,” Bruni points out.