[Population screening for cervical cancer; eventual gain not expected to increase by testing for papillomavirus]

Since the development of cervical cancer and its precursors is epidemiologically associated with oncogenic, high risk types of human papilloma virus (hrHPV), the availability of testing for hrHPV opens new dimensions for the much-criticised traditional cytological screening. It seems that hrHPV is a necessary but not in itself sufficient condition for the oncogenesis of cervical cancer. In women the prevalence of hrHPV is highest during their most active sexual phase in life, but most (> 95%) of the infections die out spontaneously and they rarely lead to cervical cancer. Only when viral infection persists together with other hitherto mostly unknown factors may cancer develop. Given the current status of research it is not advised to add testing for hrHPV to the current national screening programme or even replace cytological testing with hrHPV analysis: it makes screening definitely more complex but not better, while 'old' problems like overdiagnosis of abnormalities and subsequent overtreatment are far from being resolved.