Primary HPV Screening vs Cotesting for Cervical Cancer

To the Editor A recent Review recommended human papillomavirus (HPV) testing as the primary screening test for cervical cancer. However, the authors neglected to explore the consequences of endorsing HPV primary screening over cotesting, which includes cytological evaluation. The authors did not discuss the importance of HPV-negative neoplasms. These cases include cervical intraepithelial neoplasia grade 3 or worse (CIN3+) lesions (false-negative results as well as HPV subtypes not included in commonly used HPV testing kits) and neoplasms that are not caused by HPV, for example, about 20% of cervical adenocarcinomas. In addition, the salutary impact of HPV vaccination on the incidence of cervical cancer has the potential to be significant but must be forecast in the setting of the growing antivaccination movement in the US. Reducing death rates from cervical cancer, the long-standing goal of HPV vaccination, may not be achievable given the underwhelming vaccination rates.