title: Introduction of molecular HPV testing as the primary technology in cervical cancer screening: Acting on evidence to change the current paradigm.
abstract: Since being introduced in the 1940s, cervical cytology - despite its limitations - has had unequivocal success in reducing cervical cancer burden in many countries. However, we now know that infection with human papillomavirus (HPV) is a necessary cause of cervical cancer and there is overwhelming evidence from large-scale clinical trials, feasibility studies and real-world experience that supports the introduction of molecular testing for HPV as the primary technology in cervical cancer screening (i.e., "HPV primary screening"). While questions remain about the most appropriate age groups for screening, screening interval and triage approach, these should not be considered barriers to implementation. Many countries are in various stages of adopting HPV primary screening, whereas others have not taken any major steps towards introduction of this approach. As a group of clinical experts and researchers in cervical cancer prevention from across Canada, we have jointly authored this comprehensive examination of the evidence to implement HPV primary screening. Our intention is to create a common understanding among policy makers, agencies, clinicians, researchers and other stakeholders about the evidence concerning HPV primary screening to catalyze the adoption of this improved approach to cervical cancer prevention. With the first cohort of vaccinated girls now turning 21, the age when routine screening typically begins, there is increased urgency to introduce HPV primary screening, whose performance may be less adversely affected compared with cervical cytology as a consequence of reduced lesion prevalence post-vaccination.
authors.affiliation: Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, MD, United States; Department of Oncology, McGill University, Montréal, Québec, Canada. Electronic address: joseph.tota@nih.gov.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Tota
authors.affiliation: Department of Obstetrics & Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Bentley
authors.affiliation: Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blake
authors.affiliation: Département de microbiologie et infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Coutlée
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Máire A
authors.initials: MA
authors.lastname: Duggan
authors.affiliation: Department of Pathology, McGill University, Montréal, Québec, Canada; Department of Obstetrics & Gynecology, McGill University, Montréal, Québec, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Ferenczy
authors.affiliation: Department of Oncology, McGill University, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
authors.affiliation: Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Fung-Kee-Fung
authors.affiliation: Department of Obstetrics & Gynecology, McGill University, Montréal, Québec, Canada; Department of Oncology, McGill University, Montréal, Québec, Canada.
authors.forename: Walter
authors.initials: W
authors.lastname: Gotlieb
authors.affiliation: Département d'obstétrique-gynécologie et Médecine Sociale et Préventive, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Mayrand
authors.affiliation: Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.
authors.forename: Meg
authors.initials: M
authors.lastname: McLachlin
authors.affiliation: Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Murphy
authors.affiliation: Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Gina
authors.initials: G
authors.lastname: Ogilvie
authors.affiliation: Department of Oncology, McGill University, Montréal, Québec, Canada; Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
authors.forename: Sam
authors.initials: S
authors.lastname: Ratnam
mesh_terms: D002170:Canada; D003955:Diagnostic Tests, Routine / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000302:isolation & purification*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control* / Q000821:virology
keywords: Cervical cancer; HPV testing; Screening