Human papillomaviruses. Applications, caveats and prevention.
Unlike cervical cytology, human papillomavirus (HPV) testing provides an objective assessment of neoplasia risk. The major advantages of this technology are the potential for "reflex testing" (when used with liquid-based cytology); efficient exclusion of HPV-negative women, who can be triaged to yearly follow-up; and identification of HPV-positive women, who require colposcopic triage. However, practitioners should be aware that highly sensitive HPV tests will also identify many women with little or no immediate risk of significant neoplasia, may impose a psychosocial burden on the patient and may be used or interpreted inappropriately by both practitioners and patients. However, these caveats are similar to those inherent in any screening program involving a sexually transmitted disease, and the disadvantages of HPV testing will be minimized by attention to patient concerns and a keen awareness of the limitations of this technology. Ultimately, control of cervical cancer and its precursors rests with active prevention via vaccination programs targeting HPV. If successful, such programs could radically alter the number of women requiring triage for preinvasive disease and initiate a progressive decline in cervical cancer incidence.