We would like to thank Ms. Gilbert for her thoughtful letter regarding our Perspectives article “Why is it appropriate to recommend human papillomavirus vaccination as cervical cancer prevention?”

Regarding the improvement of healthcare provider recommendations for human papillomavirus (HPV) vaccination, we agree that there is a difficult balance between the time available for discussions of vaccination amidst the other competing priorities at each preventive care visit, compounded by the need for adolescent patients to come in for routine preventive care. We believe that creating an environment in which HPV vaccination is recommended consistently to all adolescents, regardless of sex, race, ethnicity, or socioeconomic status, is necessary. More research is needed to determine the optimal methods to inform adolescents and their parents about HPV vaccination that can streamline the provider recommendation process. Effective communication regarding vaccination at all stages of the clinical visit—appointment scheduling, check-in, clinical intake, provider encounter, and future visit scheduling—can help practices reinforce the importance of vaccination as a routine component of care, while maximizing the opportunities for information provision and questions.

Ms Gilbert also brought up the topic of HPV testing, as opposed to only Pap smear testing for cervical cancer screening. Our focus on Pap smear testing was driven by the questioning of the need for HPV vaccination given the availability of Pap smears. We agree that moving forward, there will likely be a much increased role of HPV testing in cervical cancer prevention, which combined with HPV vaccination could have a substantial impact on reducing the incidence and mortality of cervical cancer; however, given the specific concerns about the necessity of HPV vaccination when Pap smears are available, we believe it would be premature to speculate on any similar questions being raised with regard to HPV testing.

Programs such as the United States National Breast and Cervical Cancer Early Detection Program and the Vaccines for Children program have decreased socioeconomic and racial disparities in screening and HPV vaccination coverage. We strongly believe that a concerted effort to continue Pap smear testing along with HPV vaccination, and the addition of HPV testing, will offer the greatest opportunity to prevent HPV-related cancers in the United States and globally.