Implementation and impact of primary HPV testing in cervical cancer screening: Historical perspectives and institutional experience at a large academic medical center

Recognition of high-risk human papillomavirus (HPV) as the etiologic agent in nearly all cervical cancers has fundamentally reshaped screening strategies, driving the development and adoption of highly sensitive molecular HPV assays. Over the past several decades, cervical cancer screening guidelines have shifted from primarily cytology-based approaches toward HPV-based modalities, with primary HPV testing now recommended as the preferred method by the American Cancer Society and anticipated to be similarly endorsed by the United States Preventive Services Task Force. This article traces the evolution of cervical cancer screening, from the original Papanicolaou test to current guideline recommendations, and discusses the logistical requirements for transitioning to a primary HPV screening system, including triage strategies for HPV-positive cases. The authors additionally present an institutional experience of initiating primary HPV testing, highlighting its impact on cytopathology laboratory workflow and specimen volumes.