Introduction of Human Papillomavirus DNA Screening in the World: 15 Years of Experience

The discovery of the necessary cause of cervical cancer, human papillomavirus (HPV), has led to important technological advances, including the development of molecular tests for HPV to identify women with cervical precancerous lesions. HPV testing has proven to be more sensitive and more reliable, albeit less specific, for detection of cervical precancer than cytologic methods of detection. As the result, HPV testing can reduce the incidence of cervical cancer within 4–5 years and reduce the mortality due to cervical cancer within 8 years compared to cytology. Additionally, a negative HPV test provides greater reassurance against cervical cancer than a negative Pap test. HPV testing, because of its attributes, is useful for screening out low-risk women who do not need further intervention for 5 or more years. Thus, HPV testing can shift the emphasis of the use of Pap testing or any other more specific diagnostic test from frequent use in the entire population to the ∼10% subset of women who tested positive for the causal factor, HPV. Here, we highlight the current and future status of the introduction of HPV testing into routine cervical cancer screening.This article forms part of a special supplement entitled “Comprehensive Control of HPV Infections and Related Diseases” Vaccine Volume 30, Supplement 5, 2012.

► We review the rationale for using HPV testing in routine cervical screening.
► We discuss the advantages and disadvantages of primary cervical cancer screening with HPV testing alone versus HPV and cytology co-testing or cytology testing alone.
► We highlight the introduction of HPV testing in several countries.
► We discuss the possibilities and challenges of introducing HPV testing for cervical cancer screening in lower-resource settings.