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).

Arbyn M, Sasieni P, Meijer CJ, Clavel C, Koliopoulos G, Dillner J. Chapter 9: Clinical applications of HPV testing: a summary of meta-analyses. Vaccine 2006; 24 (SUPPL. 3): S78-S89.

Arbyn M, Ronco G, Meijer CJLM, Naucler P. Trials comparing cytology with HPV screening. Lancet Oncol 2009; 10: 935-6.

Bulkmans N, Berkhof J, Rozendaal L, van Kemenade F, Boeke A, Bulk S et al. Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomised controlled implementation trial. Lancet 2007; 370: 796-802.

Cuzick J, Arbyn M, Ronco G, Sankaranarayanan R, Tsu V, Mayrand M-H et al. Overview of human papillomavirus-based and other novel options for cervical cancer screening in developed and developing countries. Vaccine 2008; 26 Suppl 10: K29-K41.

Naucler P, Ryd W, Tornberg S, Strand A, Wadell G, Elfgren K et al. Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med 2007; 357: 1589-97.