[New strategies for secondary prevention of cervical cancer]

The current incidence of cervical cancer is around 5,300,000 new cases per year worldwide and mortality 275,000 cases per year. The 80% of these cases are distributed in developing countries. Cervical cancer screening should cover to as much population as possible, for instance, through public health initiative; should be use previously validated test, and based on primary care. The efficiency is the basic criterion of this screening. The Pap smear is the best technique ever used by the Preventive Medicine; and in countries with sufficient capacity and proper application, the incidence/mortality can be decreased until 75%. The introduction of DNA-HPV testing has increased the sensitivity of detecting cervical cancer, but with lower specificity. Actually it has been incorporated into the cervical screening as proposed by the Spanish Society of Obstetrics and Gynecology. The cervical screening must be maintained even in women who have been vaccinated; because of they may be at risk of contact with other high-risk HPV types not included in the vaccine. In the future, biomarkers will be of great importance. Inactivation of the retinoblastoma suppressor gene by the oncogene HPV E7 increases levels of p16INK4a in cytoplasm. Overexpression of nuclear antigen Ki67 is a marker of cell proliferation by HPV infection.