Developing role of HPV in cervical cancer prevention.

Since the Cervical Screening Programme was introduced in England, the incidence of cervical cancer has fallen by 44% and number of deaths from the disease by 70% (fig 1⇓). This effect has also been seen in other countries. 2 The discovery of human papillomavirus (HPV)DNA in cervical cancer and in subsequent molecular biology and epidemiological studies shows that persistent cervical infection with “high risk” HPV types is a necessary cause of cervical cancer. This finding has led to two major developments in cervical cancer control: immunisation as a means of primary prevention and HPV testing in cervical screening, which is poised to replace cytology as the primary screening modality. This article reviews the evidence base for evolving from exfoliative cytology alone to a dual approach of HPV vaccination and HPV based cervical screening. Who is at risk of cervical cancer?