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MODERATOR STATEMENT Rebecca B. Perkins, MD, MS From approximately 1950–2000, cervical cancers were prevented by using cytology (Pap tests), clinician-collected samples of cervical cells that used microscopic evaluation to detect precancerous changes, allowing treatment before the development of cancer. Population-wide screening at 1to 3-year intervals with cytology led to dramatic declines in cervical cancer rates, and cytology has been touted as one of the most effective cancer prevention measures to date. However, the discovery that human papillomavirus (HPV) is responsible for nearly all cases of cervical cancer, and the subsequent advent of HPV vaccination and HPV testing has the potential to revolutionize cervical cancer prevention. In the United States, both cytology andHPV testing are currently available for screening women. However, these tests perform very differently. Cytology can be thought of as an analysis of the cervix in its current state. Cells are removed and deemed either positive or negative for the possible presence of precancer. Cytology has low sensitivity,missing up to 50%of present lesions, and a single negative test does not provide long-term reassurance that cancer will not develop. Human papillomavirus testing, in contrast, detects 95% of precancer with a single screen. In addition, because persistent HPV infection is a necessary precursor of cervical precancer, a negative HPV test today means that a woman's risk of precancer is greatly reduced for the next several years. However, because HPV infections are common and most are transient, HPV testing has a higher falsepositive rate,meaning that for every test performed,morewomenwill be sent for additional testing and no precancer will be found. Current guidance exist for cytology alone, HPV tests alone, and Pap and HPV co-testing. These guidelines allow for flexibility related to the resources available in different settings nationwide but also generate confusion because clinicians struggle to determine which test or combination of tests to use, how often to

The Next Generation of Cervical Cancer Screening: Should Guidelines Focus on Best Practices for the Future or Current Screening Capacity?