Efficacy of HPV DNA testing with cytology triage and/or repeat HPV DNA testing in primary cervical cancer screening

Primary cervical cancer screening by cytological examination of cervical cells with a Pap test has reduced the incidence of cervical cancer in countries with organized screening programs ( 1, 2). However, several studies have shown that cytology has a limited sensitivity for detecting high-grade cervical intraepithelial neopla-sia (CIN), the precursor of cervical cancer ( 3, 4). Infection with high-risk types of human papillomavirus (HPV) is the major cause of cervical cancer ( 5, 6), and several cross-sectional studies ( 4, 7, 8) have reported that HPV DNA testing is more sensitive than cytology in detecting high-grade CIN. Thus far, in most countrie