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May 17, 2000

Human Papillomavirus Testing as a Screening Tool for Cervical Cancer

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(19):2525-2526. doi:10.1001/jama.283.19.2521

To the Editor: In their study of the utility of testing for high-risk human papillomavirus (HPV) in underprivileged women in rural Costa Rica, Dr Schiffman and colleagues1 suggested that in women older than 35 years, this test is comparable or even superior to the Papanicolaou (Pap) test. The concept of HPV infection as an important factor in the genesis of cancer of the uterine cervix is based on the observation that the DNA of "high risk" viruses is commonly found in nearly all invasive cancers and that viral proteins may impede events in the normal cell cycle.2 The initial theory that the mere presence of high-risk HPV is tantamount to a precancerous or malignant lesion of the uterine cervix is no longer tenable today because of very high rates of transient infections observed in sexually active young women.3 Thus, HPV testing in women aged 18 to 35 years, the age at which most of the important precancerous events occur, would be highly misleading and could result in an inordinately high level of referrals for colposcopy, perhaps as high as 30%. In the study by Schiffman et al, the rate of referral for colposcopy for women aged 18 to 30 years based on HPV testing was 21%, and 11% of women in all age groups had false-positive HPV test results.

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