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May 17, 2000

Human Papillomavirus Testing as a Screening Tool for Cervical Cancer—Reply

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

In Reply: We agree that HPV DNA testing should not be used alone for general screening of young women because of the high prevalence of infection in this age group. However, the complementary strengths of HPV testing and Pap screening can improve cervical cancer prevention.

Oncogenic types of HPV cause nearly all cases of cervical carcinoma.1 In fact, viral DNA persistence is necessary for the development of high-grade precursors and carcinomas.2,3 Consequently, HPV DNA testing is the most sensitive screening tool for the detection of serious cervical neoplasia.4 This high sensitivity is critical, because, as a corollary, the predictive value of a negative HPV test result is extremely high. The superior negative predictive value of HPV DNA testing may safely permit longer screening intervals, in addition to aiding in the triage of women with equivocal Pap test results.