Incorporating human papillomavirus testing into cytological screening in the era of prophylactic vaccines

Screening for, and treatment of, pre-cancerous cervical lesions has lead to dramatic reductions in cervical cancer in many countries. In all cases, cervical screening has been based on cytology, but that is beginning to change. Research studies, including randomised trials, clearly show that human papillomavirus (HPV) testing could be used to prevent a greater proportion of cervical cancer within a practical screening programme. Meanwhile, young adolescents are being vaccinated against HPV in developed countries, but cervical screening should continue for many years because it will take decades before most of those targeted by screening have been vaccinated. In the HPV vaccination era, the rate of cervical disease will decrease, and so will the positive predictive value of cytology. The screening characteristics of HPV testing make it the preferred choice for primary screening. However, questions regarding how to use HPV testing to screen vaccinated and unvaccinated women in the future remain unanswered.