In Reply Mr Tang and Mr Parekh contrast the approaches for cervical cancer screening discussed in my Editorial1 with the screening program used in the United Kingdom and raise provocative questions about potential future directions for cervical screening. The cervical cancer prevention environment in the United Kingdom differs from that in the United States, with government audits of screening compliance, adoption of screening and management strategies based on nationally funded prospective trials and expert consensus incorporating cost-effectiveness analysis, and certification of colposcopists.2 Much of that is lacking in the United States, and determining the population effectiveness of vaginal sampling and self-sampling will require large multisite trials. Moving to primary HPV testing (possibly including self-sampling) as the standard screen in the more decentralized health care environment of the United States will take longer.
Massad LS. Methods of Screening for Cervical Cancer—Reply. JAMA. 2018;320(18):1939. doi:10.1001/jama.2018.13943
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