Reply to: Austin et al. CytoJournal 2009;6:12 (Unfounded claims mar scientific critique)

Abstract

To the Editor, Austin and Zhao[1] raise accusations of anticytology bias and conflict of interest in the cervical cancer screening study published by Sankaranarayanan et al.,[2] which was very surprising as these were a repetition of the same previously published (and refuted) charges. The authors note that “questions have been raised” about the Alliance for Cervical Cancer Prevention (ACCP; see www.alliance-cxca.org) and its objectivity with regard to human papillomavirus (HPV) tests. They fail to acknowledge that all these questions have been repeatedly raised by the same person (lead author on all three references cited) and that they have also been answered in a peer-reviewed journal.[3] They also fail to acknowledge that the ACCP, for the past 8 years and in 20 countries, has assessed a variety of approaches to cervical cancer screening, including cytology.[4] Contrary to what is implied by Austin and Zhao, the ACCP—and, in particular, its coordinating organization, PATH—has not received any funding from the HPV test manufacturer for this or any other ACCP study. PATH has, in fact, been working with the manufacturer to develop a lower cost and simpler alternative to their current HPV test that would be more suitable for developing-country use. Unless the authors are charging that the supposed conflict of interest led to a flawed study design (in which case they should point out the flaw) or to deliberate data manipulation (a serious charge of scientific misconduct for which they must provide solid evidence), the claims simply cloud the scientific debate with unfounded accusations and do a disservice to readers. We, as members of the ACCP, are committed to making screening and treatment technologies available that are feasible and effective in low-resource settings. If our pragmatic and evidence-based approach means that we are “enamored of the promise of science,” we have no difficulty with that charge. ACCP, without industry funding, continues to undertake a coordinated research agenda to assess cervical cancer screening and treatment approaches suited to low-resource settings, to improve service delivery systems, to ensure that community perspectives and needs are considered in programs, and to heighten awareness of cervical cancer prevention. We will continue to evaluate new data as it becomes available, but we will not sit by and watch women die needlessly when we can get started now with the tools we already have at hand and for which solid data exist—including visual inspection and, when less-expensive tests become available, HPV testing.