Cervical cancer prevention and screening: the role of human papillomavirus testing

Abstract

Key content An organised screening programme has reduced the incidence of cervical cancer in the UK. Cervical screening aims to detect and treat premalignant, low‐ or high‐grade disease. Oncogenic or high‐risk human papillomaviruses (HR‐HPV) account for over 99.7% of cervical cancer cases; the most common subtypes are HPV‐16, 18, 31, 33 and 45. HPV vaccination was introduced as part of the childhood vaccination programme in 2008 and will probably save 400 lives per year. HPV testing is useful: in triage of women with borderline or low‐grade cytology; as a test of cure after treatment, in the management of uncertainty, and in primary HPV screening. Learning objectives To review the history of cervical screening and colposcopy. To understand the role of HR‐HPV in the development of cervical premalignancy and malignancy. To understand the potential of HPV vaccination and the uses of HPV testing in reducing the burden of cervical cancer. Ethical issues HPV infection is common, so should women with only transient HPV infection be informed of their diagnoses, given that disclosures provide little benefit and may cause significant emotional harm? HPV is related to other premalignant and malignant diseases of the lower genital tract and oropharynx affecting males and females. Should boys therefore be also offered HPV vaccination?