title: Human papillomavirus testing in the prevention of cervical cancer.
abstract: Strong evidence now supports the adoption of cervical cancer prevention strategies that explicitly focus on persistent infection with the causal agent, human papillomavirus (HPV). To inform an evidence-based transition to a new public health approach for cervical cancer screening, we summarize the natural history and cervical carcinogenicity of HPV and discuss the promise and uncertainties of currently available screening methods. New HPV infections acquired at any age are virtually always benign, but persistent infections with one of approximately 12 carcinogenic HPV types explain virtually all cases of cervical cancer. In the absence of an overtly persistent HPV infection, the risk of cervical cancer is extremely low. Thus, HPV test results predict the risk of cervical cancer and its precursors (cervical intraepithelial neoplasia grade 3) better and longer than cytological or colposcopic abnormalities, which are signs of HPV infection. The logical and inevitable move to HPV-based cervical cancer prevention strategies will require longer screening intervals that will disrupt current gynecologic and cytology laboratory practices built on frequent screening. A major challenge will be implementing programs that do not overtreat HPV-positive women who do not have obvious long-term persistence of HPV or treatable lesions at the time of initial evaluation. The greatest potential for reduction in cervical cancer rates from HPV screening is in low-resource regions that can implement infrequent rounds of low-cost HPV testing and treatment.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. schiffmm@mail.nih.gov
authors.forename: Mark
authors.initials: M
authors.lastname: Schiffman
authors.forename: Nicolas
authors.initials: N
authors.lastname: Wentzensen
authors.forename: Sholom
authors.initials: S
authors.lastname: Wacholder
authors.forename: Walter
authors.initials: W
authors.lastname: Kinney
authors.forename: Julia C
authors.initials: JC
authors.lastname: Gage
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
mesh_terms: D000230:Adenocarcinoma / Q000517:prevention & control / Q000821:virology; D000465:Algorithms; D052685:Alphapapillomavirus / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D014408:Biomarkers, Tumor / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000517:prevention & control / Q000821:virology; D002471:Cell Transformation, Neoplastic; D003127:Colposcopy; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000302:isolation & purification; D018450:Disease Progression; D005060:Europe; D019317:Evidence-Based Medicine; D005260:Female; D006295:Health Resources; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000191:economics / Q000379:methods; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D011634:Public Health / Q000639:trends; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears; D014765:Viral Vaccines / Q000008:administration & dosage; D002578:Uterine Cervical Dysplasia / Q000517:prevention & control / Q000821:virology
chemical_list: D014408:Biomarkers, Tumor; D004279:DNA, Viral; D014765:Viral Vaccines