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Is it feasible and what samples should be used?
A great deal has been written about the potential value of human papillomavirus (HPV) testing, particularly in the context of cervical screening programmes. Much of the published literature has focused on the assessment of specific patient groups, particularly women with mildly abnormal cervical smears, in an attempt to identify those women at greatest risk of either possessing or developing a high grade intraepithelial lesion which, according to current guidelines, requires treatment. Much of the value of HPV testing is dependent upon its high sensitivity for the detection of high grade disease and also the high negative predictive value of testing women both with low grade cytological abnormalities and in the context of primary screening.1–4 However, the duration of protection of a negative result is not yet known. These points are among those covered by the systematic review of the role of HPV testing within a cervical screening programme, published in 1999,5 and form the basis of many of the conclusions of that report. One of the other recommendations put forward was that HPV testing could potentially be applied to self collected cervical samples. In particular, this could help to improve coverage of the screened population by encouraging those who do not attend for routine cervical smears to provide samples for testing themselves. This issue is addressed in the study by Nobbenhuis et al in this issue of JCP,6 in which both a self collected cervicovaginal lavage specimen and a cervical smear were analysed cytologically and by HPV DNA testing. …