Recent conflicting results highlight the dilemmas of progress

Papers p 893

Two large studies in the United States have provided strong evidence that testing for human papillomavirus DNA is a useful tool for managing women with borderline results on cervical smear tests. 1 2 In response to those results and subsequent cost analyses, integrated managed care organisations, including Kaiser Permanente of California, have recently implemented human papillomavirus testing for managing women with atypical squamous cells of undetermined significance (ASCUS) on cervical smear tests. In the past year many health insurance plans have done the same. Consequently, a large majority of insured women in the United States now have cover for human papillomavirus testing in response to atypical squamous cells of undetermined significance. Large cytology laboratories, providing over half of US cervical smear results, encourage reflexive human papillomavirus testing for such cases. Despite this, a study by Rebello et al in this issue urges “caution in the clinical use of testing for human papillomavirus testing” (p 893).3 How do we interpret these somewhat conflicting messages about such an important issue in cervical cancer prevention?

Methodological differences may account for some of the inconsistencies between study results. The recent US reports (the Kaiser Permanente Borderline Pap …