Debate 4B - Can High-risk HPV Testing be Used Alone as the Primary Screening Modality for Cervical Cancer?

Summary

Cervical cancer, with a global incidence of 570,000 annually, causes 7.5% of all female cancer deaths. Screening has prevented about 80% of cases in developed countries. Evidence however continues to evolve on the best modality of screening. Primary screening with high-risk human papilloma virus (Hr-HPV) alone will lead to unnecessary interventions among women <30 years in whom Hr-HPV is very common but always transient. Based on this, the WHO, ACOG and United States Preventative Task Force do not recommend screening women <30 years with Hr-HPV. In addition, the American Society for Clinical Pathology advised that women undergoing Hr-HPV testing should have cytological examination at some point during their screening, as 9–10% of invasive cancers and 8.3–14% of high-grade squamous intraepithelial lesion (HSIL) are Hr-HPV negative, and Hr-HPV screening may cause delayed diagnosis and higher stage tumors. As countries transition to Hr-HPV-based screening, it is important to acknowledge the limitations and refine the utilization of the test.