Ushering in a new era: human papillomavirus (HPV) testing comes to the NHS Cervical Screening Programme

The National Health Service Cervical Screening Programme (NHSCSP) has announced that from April 2011, human papillomavirus (HPV) testing will be incorporated into the national screening programme in England. Initially, HPV testing will be used for the triage of borderline and mildly dyskaryotic smears, but there are also plans, at a later date, for its use as a ‘test of cure’ following treatment for cervical abnormalities (Figure 1).1 It would have been interesting to see the data underpinning the proposals, but no references were given. Figure 1 National Health Service Cervical Screening Programme (NHSCSP) flow diagram of ‘HPV Triage and Test of Cure Protocol for Women Aged 25 to 64 Years’.1 Figure available at: http://www.cancerscreening.nhs.uk/cervical/hpv-triage-test-flowchart-v2.pdf.1 This flow diagram is reproduced with the kind permission of the NHSCSP. The announcement follows 8 years of pilot projects. The first pilots were completed in 20062 and were followed by the Sentinel Site Implementation Project, which was launched in January 2008, to examine the practical implementation of a national roll-out of HPV testing. A report from the latter does not appear to be publicly available, so it is not possible to tell whether the problems identified in the pilots have been overcome and, if so, how. It is thus impossible to judge the results of the changes. The majority of low-grade cytological abnormalities (at least 70%) will regress without treatment.3 If it was possible to identify those women whose abnormalities were very likely to regress, they could be spared the anxiety of repeat testing and …