Emerging Technologies and Cervical Cancer

Extract

Human papillomavirus (HPV) has been demonstrated to be a necessary cause of invasive cervical cancer across epidemiologic and virologic studies worldwide (1). However, the biologic mechanisms for malignant transformation by HPV were well established long before the epidemiologic studies showed any consistency among investigators or across study designs. Once sensitive biologic assays became available for the detection of HPV, correlational, case-control, and cohort studies demonstrated high relative risks, high attributable fractions, appropriate time sequence, differential risk among higher viral load and higher risk viral types, and consistency among investigators (2). Now, with the relationship of HPV to cervical cancer established, attention has turned to how to use this information to decrease the morbidity of and mortality from cervical cancer.

Cervical cancer is the third most common cancer in women worldwide. Parkin et al. (3) estimated that 371 200 cases of cervical cancer were diagnosed worldwide in 1990, 80% of them in developing countries. In 1999, there were an estimated 12 800 cases of invasive cervical cancer and 4800 deaths from this cancer in the United States (4). The natural history of cervical cancer is well understood; lesions progress from dysplasia to carcinoma in situ to cancer. The cervix can be sampled cytologically by use of the Pap smear. Although never subjected to a randomized clinical trial, the Pap smear has decreased mortality in all countries in which cervical cancer screening programs have been established.