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There are a number of similarities between cervical cancer and oesophageal adenocarcinoma. As cervical cancer is overwhelmingly associated with oncogenic human papillomavirus (HPV) infection, the possibility that HPV is also associated with the aetiology of oesophageal adenocarcinoma needs to be examined. This paper presents the evidence for such an association and a discussion of what further studies would be needed to confirm such an association.
Evidence for an analogous association between human papillomavirus (HPV) and cervical cancer and oesophageal adenocarcinoma
HPV has been identified as the major aetiological factor in cervical carcinogenesis,1 being detected in 90–100% of cervical cancer specimens compared with 20% of controls.2 In addition, the HPV viral genome has been identified in most of the precursor lesions of cervical intraepithelial neoplasia.3 HPVs are epitheliotropic and were thought to preferentially infect squamous epithelia only. However, it is now known that much of the virus is present at the squamo–columnar junction. Moreover, a consistent, strong and robust association between infection by high-risk HPV types and risk of development of adenocarcinoma of the cervix has been demonstrated.4 5
The role of HPV-mediated tumorigenesis in cervical cancer raises the question of the possible pathogenic role of the virus in oesophageal squamous and adenocarcinoma, oropharyngeal cancers and other non-genital malignancies. The recent demonstration of an association between HPV infection and oropharyngeal cancers, and the demonstration that this association may be related to direct or indirect orogenital transmission, reveals the exposure of the upper gastrointestinal tract to HPV infection.6 There is some evidence for a plausible role for HPV in the pathogenesis of squamous cell carcinoma of the oesophagus.7 High-risk-type HPV infections (predominantly HPV16 and HPV18) are detected in about 15% and 23% of patients with oesophageal squamous carcinoma using PCR and in situ hybridisation techniques, respectively.7 HPV detection rates in oesophageal cancer are highly variable in different geographical areas of …