Clinical utility of HPV testing in cervical cancer screening

Cervical cancer remains the second most common cause of cancer death among women around the world. It has been recognized as a rare outcome of Human Papillomavirus (HPV), a common sexually transmitted infection. Persistent infection with high-risk oncogenic HPV types is a known cause of cervical cancer. The benefits of cytological screening for cervical cancer are well known. However, the necessary resources, infrastructure and technological expertise, together with the need for repeated screening at regular intervals, make cytological screening resource intense. HPV DNA testing is a viable alternative to cytological screening. With optimal testing systems, HPV DNA can be identified in nearly all specimens of invasive cervical cancer and in the vast majority (>95%) of the immediate cervical cancer precursors, namely high-grade squamous intraepithelial lesions (HSILs). HPV DNA testing has been shown to decrease cervical cancer mortality. In this chapter, the clinical utility of HPV DNA testing for cervical cancer will be reviewed with a focus on primary screening, combination with cytology (co-testing), triage for abnormal cytology, and post-treatment surveillance. The review focuses on cost and patient outcomes in a wide variety of resource settings, contrasting HPV testing to other screening strategies. Technology exists today, which could eradicate death from cervical cancer. It is time to act.