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Rebuttal by Dr Sawaya
George F. Sawaya, MD
Arch Intern Med. 2004;164:247-248.
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Mandelblatt et al raise excellent points and important issues. The strategy of adding a test for oncogenic HPV DNA in older women, for which many will have had prior normal test results, is intriguing and deserves thoughtful attention. Although the cited semi-Markov model assumes that HPV positivity by hybrid capture 2 (HC2) declines exponentially with age,1 recent prevalence studies demonstrate that HC2 positivity either increases to 12%2 or stabilizes at about 10%3-4 in women older than 60 years. Well-screened women have a low prevalence of cytologic abnormalities and cervical neoplasia. If as many as 10% are HC2-positive, clinicians should expect poor positive predictive value because of suboptimal HC2 specificity. The paradoxical association between non–high-risk HPV types and high-grade preinvasive disease in women older than 65 years also raises questions about test sensitivity.5 Importantly, the appropriate management of discordant women (those with normal cytologic findings and positive . . . [Full Text of this Article]
From the Department of Obstetrics, Gynecology and Reproductive Sciences and the Department of Epidemiology and Biostatistics, University of California, San Francisco. The author has no relevant financial interest in this article.
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