[HPV vaccination and cervical cancer screening].

In 1941, Georgios Nicholas Papanicolaou first reported that microscopic evaluation of vaginal smears might be a useful approach for detecting uterine cancer1. His work eventually led to the establishment of the Pap smear for cervical cancer screening, which is the primary reason that most high-income countries have witnessed a major decline in cervical cancer mortality2–4. More recently, discovery of human papillomavirus (hpv) as a necessary cause of cervical cancer5 has resulted in new prevention fronts: hpv vaccination and molecularbased screening technologies. In this article, we discuss current cervical cancer screening and prevention initiatives in North America and the need for a paradigm shift in the screening approach because of the negative impact that vaccination is expected to have on Pap screening performance. We make the argument that hpv testing alone should be adopted as the primary cervical screening test and might serve the added role of monitoring vaccine effectiveness. Ultimately, both hpv vaccination and hpv dna testing should be viewed as components along the continuum of care for cervical cancer prevention.