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American Journal of Epidemiology Advance Access published online on May 15, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn129
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American Journal of Epidemiology Published by the Johns Hopkins Bloomberg School of Public Health 2008

The Authors Respond to "HPV Persistence and Cervical Cancer Screening"

Jill Koshiol1, Charles Poole2, Haitao Chu3,4, Jeanne M. Pimenta5, Lisa Lindsay6, David Jenkins6 and Jennifer S. Smith2

1 Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
2 Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC
3 Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, NC
4 Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC
5 Worldwide Epidemiology, GlaxoSmithKline, Greenford, United Kingdom
6 GlaxoSmithKline Biologicals, Rixensart, Belgium

Correspondence to Dr. Jill Koshiol, National Cancer Institute, 6120 Executive Blvd., MSC 7236, Bethesda, MD 20892-7236 (e-mail: koshiolj@mail.nih.gov) or Dr. Jennifer S. Smith, CB 7435, McGavran-Greenberg Building, School of Public Health, University of North Carolina–Chapel Hill, Chapel Hill, NC 27599-7435 (e-mail: jennifers@unc.edu).

Received for publication March 27, 2008. Accepted for publication April 14, 2008.

Abbreviations: AUC, area under the ROC curve; CI, confidence interval; CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus; HSIL, high-grade squamous intraepithelial lesions; ROC, receiver operating characteristic

The first 10% of the full text of this article appears below.

We thank Dr. Castle for his constructive and contributory commentary (1) on our meta-analysis of human papillomavirus (HPV) persistence and cervical neoplasia (2). We agree that ascertaining HPV persistence may have clinical utility and that several issues must be addressed before persistence can be effectively implemented in cervical screening programs. As Dr. Castle mentioned, a single HPV test is more sensitive but less specific than a single Papanicolaou test for the detection of cervical precancer and cancer. In fact, HPV testing at a single time point has approximately 20–40 percent higher sensitivity than Papanicolaou testing and 5–10 percent lower specificity (3). Incorporating HPV persistence into routine cervical cancer screening may help to improve specificity without unduly reducing sensitivity by distinguishing women with short-term infections, and therefore lower risk of cervical precancer and cancer, from women with long-term infections, and . . . [Full Text of this Article]


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