Screening for cervical cancer represents one of the greatest successes achieved in disease prevention. Cytology has been central to cervical cancer screening programs for over 50 years and has contributed to the 70% decline in rates of cervical cancer in the developed world.³ By the 1990’s, HPV was recognized as a single, necessary cause of cancer of the cervix that was detected in 99.7% of cases of cervical cancer.⁴ Therefore, tests that detect infection with these high-risk HPV genotypes are now being used increasingly in cervical cancer screening programs.  The 2007 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests⁶ recognized the utility of using a combination of cervical cytology, tests for HPV, and genotype-specific HPV testing for women undergoing screening for cervical cancer. These guidelines were subsequently revised and now recommend the combination of cytology and HR HPV testing (cotesting) as the preferred method of screening in women ≥30 years, with HPV 16/18 genotype–specific testing an added option to triage women with negative cytology to colposcopy.⁷ Most recently, the FDA approved the use of the cobas HPV Test as the first-line primary screen and interim guidance for this screening strategy has been issued and supported by 3 professional societies.

The numerous guideline changes have presented challenges to both laboratories and clinicians. For laboratories, decisions needed to be made regarding which HPV assay to run and how to re-organize resources and workflow to accommodate changing guidelines. For clinicians, choosing the optimal screening strategy and then understanding how to manage the results has become a difficult task.

Today we will try to simplify approaches to cervical cancer screening and management by reviewing the role of HPV genotyping in risk management. Cytology and HPV genotyping results can be used to quantify risks so that we can identify women at the highest risk of having or developing cervical disease and conversely, to identify women at the lowest risk. By utilizing this risk assessment approach, laboratorians and clinicians will better be able to choose the most efficient screening methodology and also more easily manage results that are often confounding and confusing.