ABSTRACT

Cervical cancer remains a significant public health challenge in Brazil, characterized by pronounced regional disparities in both incidence and mortality rates. For several decades, the country has predominantly relied on opportunistic cervical cytology (Pap smears) for cervical cancer screening. While cytology-based screening served as a cornerstone of preventive measures, its effectiveness has been hindered by limited coverage, opportunistic administration, and deficiencies in follow-up protocols. Brazil is now undergoing a transition towards primary HPV DNA testing, commencing at age 25, in accordance with international guidelines. This perspective article critically examines the potential implications of this transition for cervical cancer prevention over the next 25 years. Evidence suggests that HPV testing provides enhanced sensitivity, facilitates earlier detection of precancerous lesions, and enables the implementation of organized, population-based screening programs. However, challenges persist, including the risk of over-referral among younger women, existing health system inequalities, and the necessity for rigorous quality assurance and follow-up mechanisms. If successfully implemented, the new strategy could enable the detection of high-grade lesions up to a decade earlier, increase screening coverage, and reduce mortality rates, particularly in underserved regions. Nevertheless, the success of this initiative will depend on sustained financial investment, integration with vaccination efforts, and the assurance of equitable access to screening services.

Keywords: Cervical cancer, HPV DNA test, Cytology, Screening, Brazil

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