Invited commentary: Is monitoring of human papillomavirus infection for viral persistence ready for use in cervical cancer screening?

Research output: Contribution to journalComment/debate

26 Scopus citations


Persistent cervical infections by approximately 15 carcinogenic genotypes of human papillomavirus (HPV) cause virtually all cases of cervical cancer and its immediate precancerous precursor, cervical intraepithelial neoplasia grade 3 or carcinoma in situ. As is shown in a meta-analysis by Koshiol et al. (Am J Epidemiol 2008;168:123-137), detection of carcinogenic HPV viral persistence could be used to identify women at the greatest risk of cervical precancer. Specifically, women who have carcinogenic HPV infection that persists for at least 1 year versus those whose infections clear are at significantly elevated risk of having or developing cervical precancer. However, before detection of HPV persistence can be used in cervical cancer screening, several considerations need to be addressed: 1) validation and Food and Drug Administration approval of a reliable HPV genotyping test, 2) rational clinical algorithms based on risk of precancer and cancer for the clinical management of HPV persistence, 3) clinician and patient acceptability of monitoring of HPV infections (including not responding excessively to the first positive HPV test and waiting 1-2 years for infections to either persist or resolve), and 4) patient compliance with recommended follow-up. Investigators will need to address these and other key issues in order to realize the potential utility of HPV viral monitoring for improving the accuracy of cervical cancer screening.

Original languageEnglish (US)
Pages (from-to)138-144
Number of pages7
JournalAmerican Journal of Epidemiology
Issue number2
StatePublished - Jul 1 2008
Externally publishedYes



  • Human papillomavirus 16
  • Human papillomavirus 18
  • Longitudinal studies
  • Papillomavirus infections
  • Uterine cervical neoplasms

ASJC Scopus subject areas

  • Epidemiology

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