[HPV testing in prevention of cervical cancer: practices and current trends]

Robust evidence supports new strategies for prevention of cervical cancer based on the detection of persistent Human papillomavirus (HPV) infection, the causative agent of the disease. New HPV infection is usually benign and transient, while persistent infection with one of -high risk HPV explains almost all of these cancers. In fact, the detection of one of the 12 oncogenic HPV increase the sensitivity of the screening and predicts, sooner than cytology, the risk of precancerous lesions, the high grade of cervical intraepithelial neoplasia (HG CIN). Negative HPV detection gives instantaneously a reassurance close to 100% of absence of disease at risk (while cytology detection is less than 60%) and almost guarantees protection of the absence of HG CIN over a prolonged period, allowing lengthening safely the screening interval to 5 years. Pooled HPV-based screening tests decrease the specificity of the screening and increases the number of colposcopy. New strategies can significantly improve the specificity of HPV screening without a significant impact on the sensitivity, including exclusion of women less than 30 years, the use of HPV DNA genotyping tests with recognition of the most HPV at risk, the 16 and 18 types. HPV alone can be used as a screening tool in women of 30 years + with a cytology triage or immunocytochemical staining of cyto slides for p16 of HPV positive. Co-testing (cytology+ HPV test) was adopted in the USA as a standard screening option.