Key content
 An organised screening programme has reduced the incidence of cervical cancer in the UK.
 Cervical screening aims to detect and treat premalignant, low- or high-grade disease.
 Oncogenic or high-risk human papillomaviruses (HR-HPV) account for over 99.7% of cervical cancer cases; the most common
subtypes are HPV-16, 18, 31, 33 and 45.
 HPV vaccination was introduced as part of the childhood vaccination programme in 2008 and will probably save 400 lives per year.
 HPV testing is useful: in triage of women with borderline or lowgrade cytology; as a test of cure after treatment, in the management of uncertainty, and in primary HPV screening.
Learning objectives
 To review the history of cervical screening and colposcopy.
 To understand the role of HR-HPV in the development of cervical premalignancy and malignancy.
 To understand the potential of HPV vaccination and the uses of HPV testing in reducing the burden of cervical cancer.
Ethical issues
 HPV infection is common, so should women with only transient HPV infection be informed of their diagnoses, given that disclosures provide little benefit and may cause significant
emotional harm?
 HPV is related to other premalignant and malignant diseases of the
lower genital tract and oropharynx affecting males and females.
Should boys therefore be also offered HPV vaccination?
Keywords: cervical cancer / cervical screening programme / HPV /HPV vaccination / human papillomavirus

Introduction

Human papillomavirus

HPV and cervical cancer

Current primary screening: cytology

Classification of cytological abnormalities

Secondary screening: colposcopy

HPV testing

HPV triage

HPV primary screening

HPV vaccination

HPV vaccination in men

Conclusion
The four cervical screening programmes in the UK are well organised and successful and they have reduced cervical cancer incidence and mortality. Given that HPV accounts for nearly all cervical cancers, the use of HPV testing is an increasingly important management tool with HPV triage introduced in
England and Northern Ireland, and HPV primary screening being evaluated for rollout across the rest of the UK.
It is hoped that HPV vaccination will ultimately reducecervical and other lower genital tract premalignant andmalignant disease, as will advances in emerging markets and
therapeutic vaccines.
As with all screening there are ethical considerations in reducing potential harm. Clinicians must provide women with accurate and sensitive information in order to reduce the
anxiety and uncertainty that may occur with a diagnosis of HPV.