REVIEW

The causal relation between human papillomavirus and cervical cancer

F X Bosch¹, A Lorincz², N Muñoz³, C J L M Meijer⁴, K V Shah⁵

¹ Institut Català d'Oncologia, Servei d'Epidemiologia i Registre del Càncer, Gran Via Km 2.7 s/n 08907 L'Hospitalet de Llobregat, 08907 Barcelona, Spain
² Digene Corporation, 1201 Clopper Road, Gaithersburg, MD 20878, USA
³ International Agency for Research on Cancer (IARC), Unit of Field and Intervention Studies, 150 Cours Albert-Thomas, F-69372 Lyon, Cedex 08, France
⁴ Vrije Universiteit Medical Center, Department of Pathology, De Boelelaan 1117, PO Box 7057–1007, 1081 HV Amsterdam, The Netherlands
⁵ The John Hopkins School of Public Health, Department of Molecular Microbiology and Immunology, 615 North Wolfe Street, Baltimore, MD 21205, USA

Correspondence to:
Correspondence to:
Dr F X Bosch, Epidemiology and Cancer Registry Unit (SERC), Catalan Institute of Oncology (ICO), Hospital Duran i Reynals, Gran Via km 2,7, L'Hospitalet de Llobregat, 08907 Barcelona, Spain;
x.bosch{at}ico.scs.es

The causal role of human papillomavirus infections in cervical cancer has been documented beyond reasonable doubt. The association is present in virtually all cervical cancer cases worldwide. It is the right time for medical societies and public health regulators to consider this evidence and to define its preventive and clinical implications. A comprehensive review of key studies and results is presented.

Keywords: human papillomavirus; cervical cancer; causality; review

Abbreviations: AF, attributable fraction; ASCUS, atypical squamous cells of undetermined significance; CI, confidence interval; CIN, cervical intraepithelial neoplasia; EBV, Epstein-Barr virus; GP, general primer; HCV, hepatitis C virus; HIV, human immunodeficiency virus; HPV, human papillomavirus; HSIL, high grade squamous intraepithelial lesion; HSV-2; type 2 herpes simplex virus; IARC, International Agency for Research on Cancer; IBSCC, international biological study on cervical cancer; OC, oral contraceptive; OR, odds ratio; ORF, open reading frame; Pap, Papanicolaou; PF, protective fraction; PCR, polymerase chain reaction; RB, retinoblastoma; RR, relative risk; STD, sexually transmitted disease; Th1, T helper cell type 1

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