Thanks to the Papanicolaou (Pap) screening practice, intervention often occurs at the pre-cancer stage of disease development, thus avoiding its progression. Pap smear screening is the current main primary prevention strategy and is widely established in the industrialised world.
There are also several tests that detect nucleic acids of high-risk HPV types. One can distinguish group tests that detect high-risk HPV infection and genotyping tests that identify separate HPV types. Currently, the utility of hrHPV testing is accepted for triage of equivocal cytology (secondary screening) and to monitor the outcome after treatment of CIN (Arbyn Vaccine 2006). Moreover, the evidence for the use of HPV testing as an alternative for cytology as primary prevention strategy is since recently being considered (Cuzick Vaccine 2008; Arbyn Lancet Oncol 2009; Naucler NEJM 2007; Bulkmans Lancet 2007).
A supplement to the EU guidelines for Quality Assurance in Cervical Cancer Screening (2nd addition) by the European Commission will be published early 2012. A recent review of these European guidelines presented as key recommendations the use of HPV testing in triage of minor cytology, follow-up after treatment, quality control of cervical cytology and in primary screening of women aged above 30 years old (M Arbyn 2011).
In the USA, the American Congress of Obstetricians and Gynecologists (ACOG), the American Cancer Society (ACS), the American Society for Colposcopy and Cervixal Pathology (ASCCP) have now recommended the use of HPV and Pap testing at each clinical visit for women over the age of 30 (Katki HA et al. 2011).
The progressive implementation of these new cervical cancer screening guidelines will allow earlier detection of women infected with High Risk HPV types, even before the appearance of any lesions. Therapeutic vaccination of such patients may allow viral clearance, prevent further transmission of the virus, promote regression of neoplasia already present and avoid disease progression to cancer.
