In Reply: We agree with Dr McCaffery and colleagues
that clinicians who perform HPV testing must understand the psychosocial ramifications
of informing a woman that she has a sexually transmitted HPV infection. Clearly,
all clinicians who provide HPV testing should be able to answer their patients'
questions regarding how they became infected with HPV, their potential to
infect current and future partners, and their risk of developing cervical
However, we do not agree that informing women that they might have a
sexually transmitted infection could have a deleterious effect on screening
programs. First, we believe that many women already know about the linkage
between HPV infections and cervical cancer and cervical cancer precursors.
The lay press has widely publicized this, and health care consumers are becoming
increasingly well-informed as a result of easy and rapid access to medical
information via the Internet. Second, since the causal relationship between
high-risk types of HPV and cervical cancer and its precursors is well established,1 it is difficult to envision how a clinician could
have a meaningful discussion regarding an abnormal cervical cytology result
without referring to HPV. A clinician's responsibility for truthfulness in
this, as in other difficult areas, requires compassionate counseling, not
denial. Irrespective of whether HPV testing is used for clinical management,
clinicians conducting cytological cervical cancer screening need to be able
to discuss issues relating to HPV infections with their patients. Finally,
it is important to recognize that receiving an abnormal cervical cytology
report is a potentially life-threatening event that is well documented to
generate tremendous anxiety.2 Human papillomavirus
testing would allow almost half of all women with ASC-US to be immediately
reassured that since they are not infected with a high-risk type of HPV, they
are at very low risk for having cervical neoplasia.
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