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Randomized and implementation studies support primary high-risk HPV testing as an effective cervical-cancer screening strategy, with greater sensitivity for clinically relevant cervical precancer than cytology alone. HPV-based screening can extend the interval between negative screens while maintaining strong protection against cervical cancer, provided abnormal results are triaged and followed appropriately. For gynecologists, the most important operational issue is the pathway after a positive HPV result. Genotyping, reflex cytology, colposcopy and treatment thresholds need to be aligned with the screening framework being used. Screening programs therefore require not only accurate tests but strong recall and referral systems. In resource-limited settings, simplified HPV-based approaches may improve reach, but program design must consider local laboratory capacity, affordability and loss to follow-up.
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Randomized and implementation studies support primary high-risk HPV testing as an effective cervical-cancer screening strategy, with greater sensitivity for clinically relevant cervical precancer than cytology alone. HPV-based screening can extend the interval between negative screens while maintaining strong protection against cervical cancer, provided abnormal results are triaged and followed appropriately. For gynecologists, the most important operational issue is the pathway after a positive HPV result. Genotyping, reflex cytology, colposcopy and treatment thresholds need to be aligned with the screening framework being used. Screening programs therefore require not only accurate tests but strong recall and referral systems. In resource-limited settings, simplified HPV-based approaches may improve reach, but program design must consider local laboratory capacity, affordability and loss to follow-up.
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