In Reply Our comprehensive Review of cervical cancer screening describes the HPV natural history underlying cervical cancer and further describes how national guidelines use this knowledge to improve care for patients by focusing on screening, diagnostic, and treatment services in higher-risk patients while decreasing testing and invasive procedures in lower-risk patients. The purpose of the article was to educate clinicians on the basic science underlying evidence-based clinical management as well as review current guidelines. Because HPV causes nearly all cervical cancers and HPV testing is more sensitive than cytology, most current guidelines recommend HPV testing, either alone or with concurrent cytology. Ms Brakebill and colleagues state that the article “recommends” primary HPV testing, which is not correct. Our article is a narrative review that summarizes current evidence and guidelines: the current US Preventive Services Task Force equally recommends primary HPV testing, cotesting, and cytology alone; the American Cancer Society guidelines recommend primary HPV testing over the other approaches when available; and the management guidelines for abnormal screening results recommend HPV-based testing, defined as either primary HPV testing or cotesting.
