The identification of HPV as the cause of cervical cancer has changed the information required for surveillance. HPV prevalence
and screening uptake worldwide are now necessary to describe the epidemiology of this cancer.
In low-income countries cervical cancer incidence varies from low to very high levels and is strongly influenced by virus prevalence. In
high-income countries, instead, incidence is low and little influenced by the virus prevalence, thanks to screening.
The European Guidelines currently recommend Pap test every 3-5 years starting at age 22-30 and stopping at age 60-65. HPV testing is
now limited to triage of borderline lesions? and to post-CIN follow up. Pilot studies evaluating HPV testing as primary test are recommended.
Future governmental agency Guidelines in Europe will probably include HPV testing as viable for primary screening, with cytology triage
for HPV-positive women (those positive to cytology will be directly referred to colposcopy, those negative will repeat HPV at one
year. Persistence of HPV positivity will refer to colposcopy directly, clearance to regular screening). The interval after an HPV-negative
test should be at least 5 years and starting age should be age 30/35. Pap test is still recommended for women under 30.
Keywords: HPV, cervical cancer, screening, vaccination, HPV testing, Pap Test, cytology, colposcopy, surveillance, lesions
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