Epidemiology of Human Papillomavirus Infections and Associations with Cervical Cancer: New Opportunities For Prevention
F. Xavier Bosch, Silvia de Sanjosé, Xavier Castellsagué, Víctor Moreno and Nubia Muñoz
from: Papillomavirus Research: From Natural History To Vaccines and Beyond (Edited by: M. Saveria Campo). Caister Academic Press, U.K. (2006)
Historical studies on cervical cancer epidemiology repeatedly pointed out associations with sexual behavioral traits of women and men and with markers of sexually transmitted diseases. When the technology was developed and allowed testing for the DNA of the Human Papillomavirus (HPV) in exfoliated cervical cells epidemiological studies were able to confirm that most of the observed associations were in fact mediated by the persistent presence of HPV DNA. The finding is of utmost importance because a group of some 15 high-risk HPV types seem to be necessary for the development of all cervical cancer cases worldwide. As a consequence, the strategies for prevention are rapidly evolving towards the incorporation of HPV tests as a screening tool and the testing of novel HPV vaccines. Evidence to date indicates that HPV tests are at least as efficient as conventional cytology as primary screening test and superior to repeated cytology in the triage of the smears of uncertain significance. Phase II trials have shown that HPV vaccines are highly immunogenic and protect women from persistent type specific HPV infections. The paradigm of cervical cancer prevention is likely to change in the forthcoming years read more ...