EFFICACY OF HPV-BASED CERVICAL CANCER SCREENING PROGRAMS: A SYSTEMATIC REVIEW

Introduction: Cervical cancer remains a preventable malignancy, yet it continues to impose a substantial global health burden, particularly in settings with suboptimal screening coverage. The recognition of persistent high-risk human papillomavirus infection as the central causal factor in cervical carcinogenesis has driven a paradigm shift from cytology-based screening toward molecular HPV-based strategies. In recent years, HPV-based screening has been increasingly implemented in organized population programs worldwide, necessitating an updated synthesis of its effectiveness. Objective: To systematically evaluate the efficacy of HPV-based cervical cancer screening programs compared with cytology-based or co-testing strategies in detecting high-grade cervical intraepithelial neoplasia and preventing invasive cervical cancer, and to assess associated benefits and potential harms relevant to clinical practice and public health policy. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, the Cochrane Library, LILACS, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. Randomized controlled trials, cohort studies, and large population-based program evaluations published primarily within the last five years were included. Outcomes of interest comprised detection rates of cervical intraepithelial neoplasia grade 2 or worse and grade 3 or worse, cervical cancer incidence, interval cancer rates, screening intervals, and colposcopy referrals. Risk of bias was assessed using RoB 2, ROBINS-I, and QUADAS-2 tools, and certainty of evidence was evaluated using the GRADE framework. Results and Discussion: Twenty studies met inclusion criteria, encompassing randomized trials, nationwide registries, and large cohort analyses. Across diverse settings, HPV-based screening consistently demonstrated higher sensitivity for high-grade cervical lesions and superior long-term protection against invasive cervical cancer compared with cytology-based screening. Extended screening intervals following a negative HPV test were shown to be safe, with sustained reductions in interval cancers. Although initial screening rounds were associated with increased colposcopy referrals, appropriate triage strategies effectively mitigated unnecessary procedures. Evidence remained robust in vaccinated populations, supporting continued use of HPV-based screening in evolving epidemiological contexts. Conclusion: HPV-based cervical cancer screening programs are more effective than cytology-based strategies in detecting clinically significant precancerous lesions and reducing cervical cancer incidence. The accumulated evidence supports HPV testing as the preferred primary screening modality, offering improved sensitivity, longer screening intervals, and enhanced program efficiency. Careful implementation with structured triage and clear patient communication is essential to maximize benefits and minimize harms, reinforcing HPV-based screening as a cornerstone of contemporary cervical cancer prevention.