The findings of Zhao et al. provide strong support for implementing HPV-based screening in China and other middle-income countries. In addition to its excellent sensitivity, an advantage of HPV testing is the high and long-lasting negative predictive value, permitting an extension of screening intervals to 5 years or more [
5]. Even one or two HPV screens in a lifetime may confer substantial preventive benefit [
2,
4]. Furthermore, HPV-based screening can successfully be implemented as a “see-and-treat” approach, where screening, triage, and treatment, e.g., by cryotherapy, are provided at the same visit [
2‐
4]. Point-of-care HPV testing platforms are available which provide rapid results and require limited skills of laboratory technicians [
3]. In addition, HPV testing can be performed on self-collected specimens, thereby obliterating the need for a gynecological exam at the initial screen [
2]. All of these features represent substantial benefits in remote areas, such as rural China, where women may need to travel long distances for screening and treatment, and where health care provider resources are limited.
Although the advantages of HPV testing are well-documented, practical implementation of an HPV-based screening program can pose substantial challenges. Policy-makers planning to implement HPV-based screening face multiple choices regarding program design, including choice of HPV test, triage method, follow-up and referral recommendation, target age range, screening interval, communication strategy, and training strategy for health care providers [
9]. The optimal choices in a specific setting will depend on the national and local context, including the availability of financial resources, health care staff, and technical capacity and infrastructure [
9,
10]. Regardless of the chosen strategy, it is essential to ensure adequate treatment of screen-identified precancerous lesions and cancers, since screening without access to treatment is unethical [
2].