The World Health Organization (WHO) recommends high- risk human papillomavirus (HR- HPV) testing as the primary method for cervical cancer screening. While HPV testing offers clear benefits in terms of sensitivity, it is costly, requires triage, and increases referrals for further management. In low- and middle- income countries like India, affordable point- of-care tests with partial genotyping are particularly relevant. While HPV assays are increasingly accessible, understanding of the critical importance of relying on internationally validated tests—such as those meeting the Meijer criteria, VALGENT framework, and WHO- TPP guidelines—remains limited.
Evidence suggests that approximately 95% of cervical cancers, and a comparable proportion of CIN3 (cervical intraepithelial neoplasia 3) lesions, are attributable to only eight HR- HPV types (16/18/31/33/35/45/52/58) with the highest oncogenic potential. In the context of cancer screening, a pragmatic balance must be struck between clinical sensitivity and specificity.
Kuhnet al. in South Africa showed that limiting HPV detection to the eight most oncogenic genotypes and adjusting cycle threshold (Ct) cutoffs in the Xpert HPV assay can achieve an optimal balance with sensitivity of 75%–85% and specificity over 90%.