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The article presents arguments in favor of human papillomavirus (HPV) primary cervical screening. Topics discussed include some large randomised trials which showed that HPV testing is more sensitive than cytology for detecting underlying high-grade cervical intraepithelial neoplasia (CIN), and the fact that some cases of CIN stage 3 are caused by non-vaccine types.

Abstract: This chapter reviews the contribution of cervical cytology, what makes it successful, the management of screen positives and how technological advances may affect its use in the future. Cervical screening has saved hundreds of thousands of lives but has not been available to women in the poorest countries. In countries where wide coverage has been achieved and quality assurance is in place, incidence and death rates have fallen by over 50% even though cervical cytology is logistically complex. The management of high-grade cervical intraepithelial neoplasia (CIN) is very effective, but low-grade cytological abnormalities require care to avoid over-treatment. The increasing rate of human papillomavirus (HPV) testing and the prospect of prophylactic vaccination will change the way cervical cytology is used, possibly giving way to HPV testing as the primary test in secondary prevention. [Copyright &y& Elsevier]