“HPV primary screening: Treading carefully…”

Screening for cervical cancer is traditionally carried out by cytology of a cervical smear.

"Nasty looking cells on a cervical smear"
“Nasty looking cells on a cervical smear”






Over the next 5 years or so, this will change worldwide to primary screening with Human Papilloma Virus (HPV) testing by PCR. This has massive implications for cervical screening services and also staff that perform cervical cytology.

In 1975, Professor zur Hausen hypothesized that human papillomavirus was a necessary cause of cervical cancer. For this he won the Nobel prize in 2008.

Professor zur Hausen
Professor zur Hausen






There is little doubt that the evidence supporting primary screening (more or less) in place of cytology is overwhelming, but this raises a few secondary questions…

  • What is the optimal screening interval, given that it takes several years for cervical cancer to develop from primary HPV infection.
  • When is the optimal age to stop screening?
  • What future impact will the recently introduced HPV vaccine have on the cost effectiveness of screening?

This is where we need to be careful. The majority of research trials into HPV testing for cervical cancer screening are carried out/sponsored by the large corporate companies that produce and sell HPV tests. These companies have a clear conflict of interest in the answers to the three questions above. This is not their fault, but the conflict is there nevertheless. We just need to be very careful with anything we read (or are given to read) on the topic

HPV is a fascinating area. If I was setting an exam on molecular testing, then HPV would be more or less at the top of my list of questions, and I am afraid I would be a ruthless examiner!


Check out this related post, “My Little Darling would never do that!”


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