Editorials

When to test women for human papillomavirus

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7533.61 (Published 12 January 2006) Cite this as: BMJ 2006;332:61
  1. Mark Schiffman, senior investigator (schiffmm@mail.nih.gov),
  2. Philip E Castle, investigator
  1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892, USA
  2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892, USA

    Cervical screening using HPV testing shows great promise but warrants caution

    Increased understanding of human papilloma-viruses (HPV) and cervical carcinogenesis has led to prevention strategies that are very promising. Two articles in this issue (pp 79, 83) find that DNA testing for HPV is a cost effective way to clarify the meaning of equivocal results of cervical cytology.1 2

    Cervical HPV infections are very common, particularly among young women, and are sexually transmitted.3 They usually clear within one or two years. However, persistent infections by 15 or so carcinogenic HPV genotypes cause most cases of cervical precancer, which is generally diagnosed years after the causal infection, and of invasive cancer, which is typically diagnosed at least two decades after infection.4

    Reproducible methods for testing for HPV are already available that are more sensitive (but less specific) than cytology for detecting prevalent and incipient precancer and cancer.5 Testing for HPV might be used to improve the four sequential steps of programmes for preventing cervical cancer: population screening, triaging equivocally abnormal cytology, diagnosing women with abnormal results linked to deciding when to treat, and assuring cure after treatment. Until recently, the standard model for prevention was based on …

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