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Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide

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It is amazing to think that cervical cancer, the fourth most common cancer type in women today, could be eliminated as a public health problem within the next decades. Cervical cancer kills more than 300 000 women per year globally, and about 90% of these deaths occur in low- and middle-income countries. Elimination of cervical cancer is possible through vaccination of adolescent girls against human papillomavirus (HPV), screening of women with HPV testing, and appropriate management of screen-detected cervical precursor lesions and cancers. In November 2020, the World Health Organization (WHO) formally adopted a global strategy to accelerate the elimination of cervical cancer as a public health problem worldwide. The strategy incorporates three specific targets to be achieved by 2030 by every country: vaccinating at least 90% of adolescent girls against HPV, screening at least 70% of women aged 30–49 years with an HPV test at least twice in their lifetime, and appropriate management of 90% of women with cervical precancer or cancer.

There is compelling evidence that primary screening with an HPV test is superior to cervical cytology or visual inspection of the cervix with acetic acid (VIA). Although the HPV tests that are currently available are expensive and are not yet widely available in all countries and regions, there is a concerted effort by all stakeholders to introduce point-of-care, affordable, and low-technology HPV tests to ensure that even low-income countries can offer HPV screening in the near future. HPV testing on self-collected vaginal samples is a significant advance that will simplify the logistic challenges of implementing HPV-based screening in all settings and empower women for self-care. There is an urgent and important need to train large numbers of health-care providers to administer HPV tests, interpret the results, and manage the screen-positive women appropriately.

Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide, an atlas from the International Agency for Research on Cancer (IARC), is a step-by-step online resource for self-learning. It covers the natural history of cervical cancer, the principles of HPV testing and different HPV tests for screening, steps for the collection of specimens for HPV testing, interpretation of the test results, and management of screen-positive women, including women living with HIV. This atlas is aligned with the latest WHO guidelines on screening and management of screen-positive women. I hope that this atlas will be an extremely useful resource for providers of cervical cancer screening and appropriate management in all countries that are implementing HPV-based cervical cancer screening.

This atlas, which is freely available online, is a valuable resource for capacity-building of providers and provides a meaningful contribution to the WHO initiative to eliminate cervical cancer as a public health problem globally.

   Dr Elisabete Weiderpass
   Director, International Agency for Research on Cancer

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