Detection, management, and follow-up of pre-malignant cervical lesions and the role for human papillomavirus.

Cervical cytological pathology is common. Prevention of cervical cancer by detecting the disease process at an early and pre-malignant stage is practised globally either through population-based screening programmes (PSP) or through non-organised ones. High-grade cervical intraepithelial neoplasia (CIN) detected by cervical cytological screening is extensively visualised by colposcopy and successively treated by, for instance, large loop electro-surgical excision of the transformation zone. Persistent infections with certain high-risk human papillomavirus (hr-HPV) genotypes play an essential role in cervical cancer carcinogenesis by mechanisms discussed in this review. HPV assessment, either DNA detection or HPV genotyping, could enhance the current cervical cancer screening programmes. Furthermore, primary prevention of cervical cancer through the introduction of HPV vaccines looks promising although the current vaccines merely protect against two hr-HPV genotypes, leaving a niche for at least 11 other hr-HPV's. Cervical screening in the post-vaccination era cannot be abolished but could be altered, as discussed in this review. Algorithms with the primary objective of hr-HPV testing followed by subjective cytology assessment in HPV-positive women could be a solution for both pre- and post-vaccination screening.