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To the Editor: Dr Wright and colleagues¹ report that human papillomavirus (HPV) testing of self-collected vaginal swabs is as sensitive as Papanicolaou tests for detecting high-grade cervical cancer in women aged 35 to 65 years. However, the results may have been influenced by verification bias. Because only women with a positive HPV result were referred for the criterion standard of colposcopy and biopsy, unbiased estimates of true-positive rates of each test cannot be computed. These rates are relative, and subsequent estimates of sensitivity and specificity are prevalence-dependent and can only apply to the sampled population.² This bias is particularly important to extrapolating these results to a lower-risk population, such as older women in the United States.

Wright et al conclude that the sensitivity of self-collected samples is lower than that of clinician-obtained samples. However, clinician-collected samples were analyzed in a different country than patient-collected samples. Furthermore, it is unclear from . . . [Full Text of this Article]

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HPV DNA Testing of Self-collected Vaginal Samples Compared With Cytologic Screening to Detect Cervical Cancer
Thomas C. Wright, Jr, Lynette Denny, Louise Kuhn, Amy Pollack, and Attila Lorincz
JAMA. 2000;283(1):81-86.
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