6 Recommendations for further research
6.1 The committee noted that human papilloma virus (HPV) primary screening is being implemented across England (see section 5.2) and that the base-case economic modelling for HPV primary screening in this assessment was based on preliminary data only (see section 5.13). The committee recommended that further studies should be done in a HPV primary screening setting. These studies should incorporate clinical outcome data and be designed to minimise verification bias. Future studies should consider measuring variability and should also take into account HPV genotyping status when possible, so that the difference in accuracy in a population vaccinated against HPV types 16 and 18 can be better understood.
6.2 The committee noted that there were no data to show how the adjunctive colposcopy technologies affect UK clinical decision-making, when all colposcopy is done by accredited colposcopists (see section 5.11). It therefore recommended that data should be collected to show how the results of the technologies affect decision-making, including biopsy decisions and decisions to discharge people with a negative colposcopy examination back to routine screening.
6.3 The committee considered that the adjunctive colposcopy technologies had the potential to improve patient experience and reduce anxiety (see section 5.8). Further research is needed to understand the effect of having the additional information provided by the adjunctive colposcopy technologies on anxiety for people having a colposcopy, when this information is shown to a person during the examination.
6.4 The committee recommended that further research is needed to better understand the natural history of low-volume cervical intraepithelial neoplasia (CIN) 2 lesions. It noted that this is not captured in the current versions of the natural history models for CIN and cervical cancer (see section 5.10), but is likely to become increasingly important for colposcopy services as HPV primary screening is rolled out and vaccinated groups enter the screening programme.