Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor
To the Editor: Dr Wright and colleagues1 report that human papillomavirus (HPV) testing
of self-collected vaginal swabs is as sensitive as Papanicolaou tests for
detecting high-grade cervical cancer in women aged 35 to 65 years. However,
the results may have been influenced by verification bias. Because only women
with a positive HPV result were referred for the criterion standard of colposcopy
and biopsy, unbiased estimates of true-positive rates of each test cannot
be computed. These rates are relative, and subsequent estimates of sensitivity
and specificity are prevalence-dependent and can only apply to the sampled
population.2 This bias is particularly important
to extrapolating these results to a lower-risk population, such as older women
in the United States.
Fontanarosa PB, Moselhi M. Human Papillomavirus Detection to Screen for Cervical Cancer. JAMA. 2000;284(1):39–40. doi:10.1001/jama.284.1.39
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