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Comment & Response
November 13, 2018

Methods of Screening for Cervical Cancer

Author Affiliations
  • 1School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
JAMA. 2018;320(18):1938-1939. doi:10.1001/jama.2018.13939

To the Editor In an Editorial, Dr Massad1 discussed the benefits of liquid-based cytology vs human papillomavirus (HPV) testing for cervical cancer screening and suggested that using both tests together may be necessary until a higher proportion of the population is vaccinated against HPV. Perhaps a more cost-effective approach would be to use a single screening test with a relatively high sensitivity to identify women who require further testing or more regular follow-up. In the United Kingdom, cervical screening is performed every 3 years for women aged 25 to 49 years and then every 5 years from age 50 to 64 years.2 Abnormalities are reported as borderline, mild, moderate, and severe based on the epithelial cells sampled. Women with test results reported as borderline or mild are offered HPV testing, followed by colposcopy if found to be positive, whereas women with test results reported as moderate or severe are referred for urgent colposcopy. As most HPV infections will regress and only lesions representing cervical intraepithelial neoplasia grades 2 or 3 have a high risk of developing into invasive cervical cancer, liquid-based cytology may be a more useful tool to assess risk of progression to carcinoma than HPV testing alone.