Implementation efforts to support transition to HPV-based cervical cancer screening

Abstract

On average, it takes 15 years from the landmark publication on a cancer control evidence-based intervention to achieve 50% uptake in routine practice.¹ In fact, nearly 20 years have passed since the first observational studies showed that human papillomavirus (HPV) DNA testing had substantially higher sensitivity for detecting cervical precancer and cancer compared with cervical cytology.² Since then, the performance of HPV testing in primary cervical screening has been evaluated globally, and several large randomised controlled trials have shown that a negative HPV test provides long-term protection against invasive cervical cancer.3, 4 In line with this evidence, the WHO 2021 and the WHO 2024 guidelines recommend the use of HPV testing over cervical cytology or visual inspection of the cervix (VIA) in primary screening to prevent cervical cancer following simple algorithms for either screen-and-treat, or screen, triage (using cytology, dual-stain [p16/Ki67] cytology, VIA, or colposcopy), and treat. Despite the evidence and recommendations supporting HPV detection as primary screening test, it has not yet led to widespread transition from cytology-based to HPV-based cervical screening.