Primary HPV screening for cervical cancer

• Published in: Best practice & research. Clinical obstetrics & gynaecology 2020-05, Vol.65, p.98-108
• Main Authors: Bhatla, Neerja, Singhal, Seema
• Format: Article
• Language: English
• Subjects: Cervical cancer; Elimination; HPV test; Screening; Triage
• ISSN: 1521-6934; 1532-1932
• DOI: 10.1016/j.bpobgyn.2020.02.008

Cytology-based cervical screening had unequivocal success in reducing the incidence and mortality of cervical cancer in the last century. The recognition of the role of human papillomavirus (HPV) as a necessary cause of cervical cancer led to the development of HPV testing. Gradually, there has been a shift from reflex HPV testing for mild cytological abnormalities, to co-testing with cytology and HPV, and lately to primary HPV screening, based on evidence from well-designed large randomized controlled trials and meta-analyses. Advantages of primary HPV screening include higher sensitivity to detect pre-neoplastic lesions, better re-assurance with a negative test, and safe prolongation of screening intervals. However, clinicians and policy makers must ensure the availability of clinically validated HPV assays and triage protocols of screen positive cases prior to implementation of primary HPV screening. This is likely to reduce potential harm from over-treatment as well as extra burden on the health care system. •The high sensitivity of HPV test (95%) makes it ideal for primary screening.•A negative HPV test provides better reassurance and allows safe prolongation of screening interval.•HPV test is more effective in detecting glandular lesions and precursors of adenocarcinoma.•HPV testing is more suitable for screening HPV-vaccinated populations.