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July 5, 2000

Human Papillomavirus Detection to Screen for Cervical Cancer

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;284(1):39-40. doi:10.1001/jama.284.1.39

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.