An Organised Cervical Cervical Screening Programme

Iceland has provided organised cervical cancer screening since 1964, with the aim of reducing incidence and mortality through early detection and timely treatment. Initially managed by the Icelandic Cancer Society, the programme has been coordinated by the Cancer Screening Coordination Centre since 2021. The Centre operates under the Primary Health Care of the Capital Area and is responsible for nationwide coordination in accordance with national guidelines, including sending invitations, delivering results, coordinating follow-up, and providing public information.

Screening Guidelines

The Directorate of Health oversees the publication of national screening guidelines, establishes quality indicators and performance benchmarks, and conducts quality assurance through monitoring programme implementation and outcomes.

HPV

Women aged 23–64 years are eligible for cervical cancer screening. Women aged 23–29 are invited every three years, while those aged 30–64 are invited every five years. Women with abnormal results receive follow-up in line with national guidelines. Cervical cancer screening was previously cytology-based; however, updated guidelines introduced HPV-based primary screening for women aged 30–64 in 2021, with expansion to women aged 23–29 in 2024. HPV sampling is performed by midwives or nurses at primary health care centres, where the fee is approximately €3 (500 ISK), or alternatively by gynaecologists where fees vary according to individual clinic price lists. All samples are analysed at Landspítali University Hospital.

Invitations and Results

Invitations to screening are issued digitally and by post, based on age and screening history. Women book appointments at primary care centres or with gynaecologists. Test results are delivered electronically and include recommendations for future screening or follow-up.

Statistics

In 2024, the participation rate in the population-based screening programme was 64%, below the target of 75%. Participation varies considerably between subgroups. Women with Icelandic citizenship had an attendance rate of 75%, compared with 31% among women with non-Icelandic citizenship. Lower participation is also observed among younger women, particularly those aged 23–29.

Initiatives

Several initiatives have been implemented to improve participation, especially among underrepresented groups. Invitation letters and informational materials have been translated into English and Polish, reflecting the largest migrant population in Iceland. Multilingual posters have been distributed in public spaces to raise awareness of screening availability, affordability, and employees’ right to attend screening during working hours. Collaboration has also been established with the Women of Multicultural Ethnicity Network in Iceland (W.O.M.E.N.), along with other stakeholders, to address barriers faced by migrant women.

Accessibility

To improve accessibility, many primary health care centres now offer drop-in appointments, including special afternoon sessions. Results from the pilot indicated that approximately 60% of women attending afternoon drop-in sessions had non-Icelandic citizenship, compared with only 30% among those attending screening during regular working hours. Based on these findings, the decision was made to continue offering afternoon drop-in appointments, with the aim of making the programme more inclusive and reducing participation disparities.

Reducing Barriers

While Iceland’s cervical cancer screening programme offers effective nationwide HPV-based screening, participation remains below target. Continued efforts to strengthen outreach, improve accessibility, and reduce barriers for migrant and younger women are essential to enhance coverage and maximise the programme’s public health impact.