Exfoliative Cytology to Epigenetic Markers: Molecular Advances in Human Papillomavirus Detection for Cervical Cancer Screening

Cervical cancer has been a major cause of morbidity and mortality in women worldwide, with higher burden in low- and middle-income countries. The etiopathogenesis of cervical carcinoma suggests the direct involvement of sexually transmitted persistent infection by human papillomavirus. Persistent infection leads to the development of preinvasive lesions, which progress into carcinoma if not detected and treated appropriately. Cervical carcinoma is a largely preventable disease through a combination of increased awareness, broad vaccination coverage, universal screening, and timely intervention. There has been a transition in the preferred modalities from conventional screening methods like conventional Pap and liquid-based cytology to advanced human papillomavirus (HPV) detection tests, which has favorably transformed global screening frameworks. Food and Drug Administration-approved and WHO-recommended HPV detection methods are well established and are already being used as stand-alone tests. In alignment with this transition, novel and upcoming techniques are being developed with enhanced sensitivity and specificity, increased accuracy, improved economic sustainability, expansive outreach, and reduced unwarranted testing. This article explores the practical implementation, advantages, challenges, and overall impact of the existing techniques such as pap cytology, visual inspection with acetic acid or Lugol’s iodine, HPV-DNA/messenger RNA detection assays as well as upcoming modalities such as DNA methylation tests, point-of-care tests, and MicroRNA, for cervical cancer screening and control. It also provides insights into the suitability of each test as an effective screening tool and how its robust use may help us in achieving the 90-70-90 targets set by the World Health Organization. Comprehensive, well-structured, and efficiently implemented screening strategies facilitate stronger cervical cancer control and support its ultimate elimination.