Increased understanding of human papilloma-viruses (HPV) and cervical carcinogenesis has led to prevention strategies that are very promising. Two articles in this issue (pp 79, 83) find that DNA testing for HPV is a cost effective way to clarify the meaning of equivocal results of cervical cytology.1 2

Cervical HPV infections are very common, particularly among young women, and are sexually transmitted.3 They usually clear within one or two years. However, persistent infections by 15 or so carcinogenic HPV genotypes cause most cases of cervical precancer, which is generally diagnosed years after the causal infection, and of invasive cancer, which is typically diagnosed at least two decades after infection.4

Reproducible methods for testing for HPV are already available that are more sensitive (but less specific) than cytology for detecting prevalent and incipient precancer and cancer.5 Testing for HPV might be used to improve the four sequential steps of programmes for preventing cervical cancer: population screening, triaging equivocally abnormal cytology, diagnosing women with abnormal results linked to deciding when to treat, and assuring cure after treatment. Until recently, the standard model for prevention was based on …