Primary screening by human papillomavirus testing: Development, implementation, and perspectives

With the discovery that human papillomavirus (HPV) is the leading cause of cervical cancer development, it soon became clear that screening by HPV testing is much more sensitive, reproductive, and objective, but less specific for cervical cancer screening than cytology. To compensate for the lower specificity, triage tests for HPV positive women are needed. In this chapter we discuss the original studies underlining the evidence for the introduction of HPV-based screening. We highlight different collection techniques of cervicovaginal material for HPV and triage testing, including self-sampling, different triage tests to select HPV positive women for colposcopy referral, and describe developments, which may result into full molecular self-screening. Finally the implementation of HPV-based screening in some Western countries is highlighted.