Re: Human Papillomavirus Testing in the Prevention of Cervical Cancer

Extract

We agree with Schiffman et al. ( 1 ) that judicious introduction of high-quality human papillomavirus (HPV) tests such as Hybrid Capture 2 (HC2; Qiagen Corporation, Gaithersburg, MD) may increase the efficiency and effectiveness of cervical screening programs that have already achieved high coverage rates of populations at high risk for the development of cervical cancer. We also agree that quality-management obstacles intrinsic to visual screening tests make it difficult to recommend visual screening for any setting where Papanicolaou screening is feasible, which includes essentially all settings where cervical screening is appropriate ( 2 ). However, we disagree with the belief promulgated by Schiffman et al. ( 1 ) that developing countries should “bypass cytology” in planning for HPV screening. This belief appears to have been assimilated by global health leaders at the Bill & Melinda Gates Foundation, who currently promote HPV screening and HPV vaccination, but not Papanicolaou screening, in developing countries such as Vietnam ( 2 ). Acting on such beliefs is likely to decelerate global reductions in cervical cancer–related mortality, particularly in regions that currently have cervical screening programs with low population coverage rates, by suppressing the more rapid uptake of less expensive open-source technology in favor of the less rapid uptake of more expensive proprietary technologies with uncertain real-world advantages and unfavorable real-world operational limitations ( 2 ).