Cervical cancer prevention has undergone dramatic changes over the past decade. With the introduction of human papillomavirus (HPV) vaccination, some countries have seen a dramatic decline in HPV‐mediated cervical disease. However, widespread implementation has been limited by economic considerations and the varying healthcare priorities of different countries, as well as by vaccine availability and, in some instances, vaccine hesitancy amongst the population/government. In this environment, it is clear that cervical screening will retain a critical role in the prevention of cervical cancer and will in due course need to adapt to the changing incidence of HPV‐associated neoplasia. Cervical screening has, for many years, been performed using Papanicolaou staining of cytology samples. As our understanding of the role of HPV in cervical cancer progression has advanced, and with the availability of sensitive detection systems, cervical screening now incorporates HPV testing. Although such tests improve disease detection, they are not specific, and cannot discriminate high‐grade from low‐grade disease. This has necessitated the development of effective triage approaches to stratify HPV‐positive women according to their risk of cancer progression. Although cytology triage remains the mainstay of screening, novel strategies under evaluation include DNA methylation, biomarker detection and the incorporation of artificial intelligence systems to detect cervical abnormalities. These tests, which can be partially anchored in a molecular understanding of HPV pathogenesis, will enhance the sensitivity of disease detection and improve patient outcomes. This review will provide insight on these innovative methodologies while explaining their scientific basis drawing from our understanding of HPV tumour biology.

中文翻译：

---

宫颈癌的早期发现。宫颈疾病检测的当前和不断变化的格局。


在过去的十年中，宫颈癌的预防发生了巨大的变化。随着人乳头瘤病毒 (HPV) 疫苗的引入，一些国家的 HPV 介导的宫颈疾病急剧下降。然而，广泛实施受到经济考虑和不同国家不同的医疗保健优先事项以及疫苗可用性以及在某些情况下民众/政府对疫苗犹豫不决的限制。在这种环境下，很明显，宫颈筛查将在预防宫颈癌中发挥关键作用，并在适当的时候需要适应 HPV 相关肿瘤发病率的变化。多年来，宫颈筛查一直使用细胞学样本的巴氏染色进行。随着我们对 HPV 在宫颈癌进展中的作用的了解不断深入，并且随着敏感检测系统的出现，宫颈筛查现在纳入了 HPV 检测。尽管此类测试改善了疾病检测，但它们不具有特异性，并且无法区分高级别和低级别疾病。这就需要开发有效的分类方法，根据癌症进展的风险对 HPV 阳性女性进行分层。尽管细胞学分类仍然是筛查的主要手段，但正在评估的新策略包括 DNA 甲基化、生物标志物检测以及结合人工智能系统来检测宫颈异常。这些检测部分基于对 HPV 发病机制的分子理解，将提高疾病检测的敏感性并改善患者的治疗结果。 这篇综述将提供对这些创新方法的见解，同时根据我们对 HPV 肿瘤生物学的理解解释其科学基础。