Cervical cancer screening: the shift from Pap smear to HPV-based strategies

Abstract Introduction Cervical cancer remains one of the most preventable malignancies in the world, and while effective screening and prophylactic human papillomavirus (HPV) vaccines have significantly reduced disease risk, it continues to cause substantial morbidity and mortality. For years, cervical cancer screening has relied on cervical cytology—Pap smear test which examines cells from the cervix to detect abnormalities before they progress to cancer. However, given the well-established etiological link between HPV infection and cervical cancer, testing for HPV has emerged as a superior alternative to the Pap smear. Purpose The aim of this paper was to examine the recent transition from Pap smear to HPV-testing as the primary cervical cancer screening method, review the supporting evidence, highlight key benefits and challenges, and discuss future directions toward the global goal of cervical cancer elimination. Materials and methods A comprehensive literature review was conducted using PubMed and Google Scholar to identify relevant studies published from 1995 to 2025 on the topics of cervical cancer, Pap smear and its history, and HPV-based screening. Articles were selected based on relevance, study quality, and recency. Discussion The transition from cytology-based screening to HPV testing marks a significant advancement in cervical cancer prevention. Evidence consistently shows that HPV testing offers superior sensitivity for identifying individuals at risk, allowing for earlier detection and extended screening intervals. This shift has been reflected in updated guidelines worldwide, with many countries now recommending HPV-based screening as the primary method. Key words: cervical cancer, prevention, screening, human papillomavirus, HPV, cervical cytology, pap smear, dual-stain