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September 18, 2002

Testing for Human Papillomavirus in Women With Abnormal Pap Smear Results—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(11):1350. doi:10.1001/jama.288.11.1350

In Reply: We agree with Dr McCaffery and colleagues that clinicians who perform HPV testing must understand the psychosocial ramifications of informing a woman that she has a sexually transmitted HPV infection. Clearly, all clinicians who provide HPV testing should be able to answer their patients' questions regarding how they became infected with HPV, their potential to infect current and future partners, and their risk of developing cervical cancer.

However, we do not agree that informing women that they might have a sexually transmitted infection could have a deleterious effect on screening programs. First, we believe that many women already know about the linkage between HPV infections and cervical cancer and cervical cancer precursors. The lay press has widely publicized this, and health care consumers are becoming increasingly well-informed as a result of easy and rapid access to medical information via the Internet. Second, since the causal relationship between high-risk types of HPV and cervical cancer and its precursors is well established,1 it is difficult to envision how a clinician could have a meaningful discussion regarding an abnormal cervical cytology result without referring to HPV. A clinician's responsibility for truthfulness in this, as in other difficult areas, requires compassionate counseling, not denial. Irrespective of whether HPV testing is used for clinical management, clinicians conducting cytological cervical cancer screening need to be able to discuss issues relating to HPV infections with their patients. Finally, it is important to recognize that receiving an abnormal cervical cytology report is a potentially life-threatening event that is well documented to generate tremendous anxiety.2 Human papillomavirus testing would allow almost half of all women with ASC-US to be immediately reassured that since they are not infected with a high-risk type of HPV, they are at very low risk for having cervical neoplasia.