© 1995 by Oxford University Press
Journal of the National Cancer Institute, Vol. 87, No. 11, 796-802,
June 7, 1995
© 1995 Oxford University Press
Prevalence of Human Papillomavirus in Cervical Cancer: a Worldwide Perspective
Servei d'Epidemiologia i Registre del Càncer, Institut Catala d'Oncologia Hospital Duran i Reynals, CSUB, Autovia Castelldefels, km. 2.7, E-08907 L'Hospitalet del Llobregat, Barcelona, Spain
Department of Molecular Microbiology and Immunology, School of Public Health, Johns Hopkins University University, Baltimore, Md.
Unit of Field and Intervention Studies, International Agency for Research on Cancer Lyon, France
Department of Pathology, Johns Hopkins Medical Institutions Bethesda, Md.
Institute of Cancer Research Belmont, Surrey, England
Environmental Epidemiology Branch, National Cancer Institute Bethesda, Md.
Nubia Muñoz, M.D., International Agency for Research on Cancer, 150, Cours Albert Thomas, F-69372 Lyon Cedex 08, France
BACKGROUND: Epidemiologic studies have shown that the association of genital human papillomavirus (HPV) with cervical cancer is strong, independent of other risk factors, and consistent in several countries. There are more than 20 different cancer-associated HPV types, but little is known about their geographic variation.
PURPOSE: Our aim was to determine whether the association between HPV infection and cervical cancer is consistent worldwide and to investigate geographic variation in the distribution of HPV types.
METHODS: More than 1000 specimens from sequential patients with invasive cervical cancer were collected and stored frozen at 32 hospitals in 22 countries. Slides from all patients were submitted for central histologic review to confirm the diagnosis and to assess histologic characteristics. We used polymerase chain reaction-based assays capable of detecting more than 25 different HPV types. A generalized linear Poisson model was fitted to the data on viral type and geographic region to assess geographic heterogeneity.
RESULTS: HPV DNA was detected in 93% of the tumors, with no significant variation in HPV positivity among countries. HPV 16 was present in 50% of the specimens, HPV 18 in 14%, HPV 45 in 8%, and HPV 31 in 5%. HPV 16 was the predominant type in all countries except Indonesia, where HPV 18 was more common. There was significant geographic variation in the prevalence of some less common virus types. A clustering of HPV 45 was apparent in western Africa, while HPV 39 and HPV 59 were almost entirely confined to Central and South America. In squamous cell tumors, HPV 16 predominated (51% of such specimens), but HPV 18 predominated in adenocarcinomas (56% of such tumors) and adenosquamous tumors (39% of such tumors).
CONCLUSIONS: Our results confirm the role of genital HPVs, which are transmitted sexually, as the central etiologic factor in cervical cancer worldwide. They also suggest that most genital HPVs are associated with cancer, at least occasionally.
IMPLICATION: The demonstration that more than 20 different genital HPV types are associated with cervical cancer has important implications for cervical cancer-prevention strategies that include the development of vaccines targeted to genital HPVs. [J Natl Cancer Inst 87:796–802, 1995]
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- Epidemiologic Studies of a Necessary Causal Risk Factor: Human Papillomavirus Infection and Cervical Neoplasia
- Mark H. Schiffman and Philip Castle
J Natl Cancer Inst 2003 95: 2E.[Extract] [Full Text]
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