Update on primary HPV screening for cervical cancer prevention.

In the coming decade, primary testing for human papillomavirus (HPV) will likely become the standard of care for cervical cancer screening in both low- and high-resource settings. This change comes as evidence has accumulated to support HPV testing as more sensitive to detect high-grade precancerous disease. Furthermore, negative HPV testing has demonstrated a lower cumulative incidence of cervical intraepithelial neoplasia (CIN) grade 3 or worse pathology (CIN3+) when compared to negative "Pap smears" over several rounds of screening. While many countries have begun pilot programs to transition to primary HPV screening and some have completely transitioned for certain uses, there remains much to be refined about this tool for cervical cancer prevention, as evidenced by the myriad of ways it is being utilized. In the United States, the use of primary HPV testing to screen for cervical cancer has been supported by a consensus statement from the Society of Gynecologic Oncologists and American Society for Colposcopy and Cervical Pathology along with experts from American College of Obstetricians and Gynecologists/American Cancer Society/American Society of Cytopathology/College of American Pathologists/and American Society for Clinical Pathology. Additionally, recently proposed United States Preventive Services Task Force guideline changes, and recent Food and Drug Administration approval of the second test for primary HPV screening highlight the broadening availability and support for primary HPV screening. The aim of this review is to summarize the evidence supporting the safety and effectiveness of primary HPV screening and its use in different high-resource settings.