We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Cervical Cancer Screening by Human Papillomavirus Testing Followed by Cytology Triage—Reply

Sarah Feldman, MD, MPH1
[+] Author Affiliations
1Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Intern Med. 2015;175(6):1068-1069. doi:10.1001/jamainternmed.2015.0596.
Text Size: A A A
Published online


In Reply Giorgi-Rossi et al take issue with my concern that primary human papillomavirus (HPV) testing might increase costs, in particular for colposcopies. They cite as evidence the European trials and note “strong evidence of a lack of difference between” primary HPV testing followed by cytology-based testing vs screening based on Papanicolaou testing. However, as I stated, these types of analyses depend on the exact protocols being studied (ie, frequency of screening as well as appropriateness of subsequent testing) as well as the actual adherence of practitioners to the designated protocol. In health systems with a universal approach to screening and comprehensive outcomes registries to monitor the adherence to the recommended protocol, the trial findings might apply. Clinical practice, however, varies tremendously across the United States; it is not known how primary HPV testing will perform in diverse practice settings until it is studied. Such factors as the available tests, the costs attributed to those tests, and the preferences of clinicians and patients are more variable in the United States than in Europe. Changes to guidelines1 before there is strong evidence about the best approach may be ill advised. Such changes may increase confusion or lead to overevaluation and treatment of transient HPV infections or inadvertent increases in cancers.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





June 1, 2015
Paolo Giorgi-Rossi, PhD; Marc Arbyn, MD; Chris J. L. M. Meijer, MD
1Interinstitutional Epidemiology Unit, AUSL (Azienda Unità Sanitaria Locale) Reggio Emilia, Reggio Emilia, Italy2Arcispedale S. Maria Nuova, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Reggio Emilia, Italy
3Unit of Cancer Epidemiology and Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
4Department of Pathology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
JAMA Intern Med. 2015;175(6):1068. doi:10.1001/jamainternmed.2015.0592.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...