Switzerland needs to improve cervical cancer screening

A speculum and a swab are used to take a sample from the cervix for HPV tests and Pap smears. Keystone / Science Photo Library

A national programme to prevent cancers caused by human papillomavirus (HPV) is underway in Switzerland and might give the country the opportunity to catch up with the rest of Europe. A Swissinfo analysis.

Key Takeaways

• The Swiss parliament has approved a national policy against HPV, which causes 75-100 annual deaths from cervical cancer.

• Unlike many European countries, Switzerland does not reimburse the more precise HPV test.

• A request has been submitted to the federal authorities for the HPV test to be covered by health insurance.

Some twenty years ago, I was vaccinated against human papillomavirus (HPV), the most transmitted sexual infection in the world and the main cause of cervical cancer. I remember waiting alongside my mother with hundreds of girls my age in an incredibly long line at the University of Geneva’s medical faculty.

That was back in 2008, and 22,000 girls in Geneva were eligible for the free shotExternal link as part of the cantonal vaccination policy. A vaccine had recently been approved by Switzerland and the country was in line with its neighbours who were also recommending the shot and offering varying levels of reimbursement.

HPV vaccines

Vaccines are preventative and highly effective against HPV, a group of 200 viruses that mostly cause non-concerning infections. But high-risk HPV infections lead to genital warts and cause 99% of cervical cancers, the fourth most-common type of cancer among women, behind breast, lung, and colorectal. High-risk HPV viruses can also lead to anal, head and neck, vaginal, vulvar and penile cancers, according to more recent research.

By 2020-2022, 71% of 16-year-old girls in Switzerland had received the two shots and were fully vaccinated, double the rates reported between 2008 and 2010. This was similar to rates in Belgium, Finland, Hungary, Ireland and Lithuania for 15-year-old girls in 2024, according to the European Centre for Disease Prevention and Control (ECDC). Neighbouring countries Austria (just above 60%), France (below 50%), Germany and Italy (around 55%) all reported lower vaccination rates than Switzerland.

But vaccination policies are left to the cantons and rates varied greatly depending on where you lived. While some cantons reported a vaccination rate of 26% among girls in 2024, others were as high as 82%.

To end this disparity and eliminate HPV-related cancers, including the most-common one – cervical cancer – which claims 75 to 100 lives a year, both chambers of the Swiss parliament agreed at the beginning of June to the development of the country’s first national policy against the virus.

To do this, Switzerland plans to vaccinate 90% of its girls and boys (the latter began to be included in vaccination campaigns from 2015 when studies indicated HPV could also lead to cancers in men). As of 2024, Portugal is the only country to reach that goal among 15-year-olds (Iceland and Norway only reached it among girls).

Pap smears vs HPV tests

But vaccines aren’t enough to eliminate HPV-related cancers because they aren’t 100% effective, and because the first shots were only developed around 2006, meaning that many Swiss residents were never vaccinated.

So to protect its population, the proposed bill also highlights the importance of screening.

Enter the Pap smear: a near-century-old screening method developed in 1928 in the United States by Dr. Georgios Papanikolaou, who lends his name to the exam. The test detects early-stage cancers by sampling cells in the cervix (the lower part of the uterus) and looks for abnormalities. It is sometimes referred to as cervical cytology.

To reach the area, doctors must use a vaginal speculum, a two-bladed tool sometimes compared to a torture device External linkthat was designed about 150 years ago to push back the vaginal walls. A swab is then inserted to gently scrap the surface of the cervix and collect cells. It is highly invasive, usually uncomfortable, and can be quite painful – but that’s another topic.

Pap smears are highly effective in detecting abnormal cells and are credited with a 70% to 90% reduction in cervical cancers. The test was introduced in Switzerland in the 1970s, is recommended every year for women between 21 and 29, and every three years from 30 years old. The procedure costs about CHF50 ($63) and is covered by health insurance every three years.

There is an even better method to detect HPV-related cancers, however. It’s called an HPV test and instead of looking at the appearance of cells, it checks the presence or absence of the virus in a sample that is collected in the same way as for a Pap smear. The test was developed in the early 2000s and gradually became the “gold standard” of HPV screening for women over 30 because it is more precise. It identifies the virus before it causes cells to mutate, whereas the Pap smear identifies precancerous and abnormal cells.

This is where Switzerland isn’t doing so well. Most European countries, including Belgium, France, Germany, Italy have made the switch. The newer test is also common in the United States, the United Kingdom, Turkey, Thailand and China.

A case for reimbursement

In Switzerland, HPV testing is available, but not covered by health insurance. Patients must pay about CHF160. This is quite unexpected from a country that boasts having one of the best health systems in the world.

>>How Switzerland deals with colorectal cancer:

Back in 2012, the Swiss Society for Gynaecology and Obstetrics (SGGG) was aware that HPV tests were “revolutionising” screenings, according to one of its expert opinionsExternal link.

In August 2021, a pilot cancer screening committee recommended reimbursement to the Federal Office of Public Health (FOPH). In February 2025, the SGGG, together with the HPV Alliance and the Swiss Cancer League, submitted a request for reimbursement to FOPH.

It takes years and hundreds of thousands of francs to compile an FOPH reimbursement request due to the need for scientific evidence, economic analysis and health technology assessments – a particularly difficult task for those outside big pharma structures.

The process is still ongoing and it could take years before the tests are reimbursed.

Thanks to its high quality of care, Switzerland has one of the world’s lowest cervical cancer death rates, but every year, around 2,400 women are diagnosed with pre-cancerous lesions and 250 are diagnosed with cancer. These might require aggressive treatment. About 75 women also die annually due to cervical cancer – a cancer that can be eliminated via screening and vaccination. Early detection can save lives and Switzerland should adopt the gold standard of screening.

Join the debate:

Edited by Virginie Mangin/sb