COMMENTS AND RESPONSES Screening for Cervical Cancer

TO THE EDITOR: Whitlock and colleagues ’ article (1) evaluated the use of human papillomavirus (HPV) testing and cytology in cervical cancer screening and concluded that more evidence is needed to determine the optimal approach. Their review evaluated the different possible screening strategies (HPV testing alone, HPV testing alone with cytology triage, HPV testing plus cytology screening [cotesting], and cotesting with cytology triage) separately versus cytology alone and considered only results on prevention of invasive cancer. Evidence has conclusively shown that HPV testing can detect approximately 50 % more cases of high-grade cervical intraepithelial neoplasia (CIN), an established precursor to cancer, than cytology at an initial screening (2). Furthermore, all randomized, controlled tri-als conducted in industrialized countries (3–6) have shown a similar reduction in detection of CIN3 after HPV testing. This finding indicates that HPV testing can detect nonregressiv