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Cervical cancer
  1. P J van Diest1,
  2. H Holzel2
  1. 1Department of Pathology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
  2. 2Formerly at Great Ormond Street Hospital for Children NHS Trust, London WC1N 3 JH, UK.
  1. Correspondence to:
 Dr PJ van Diest, Department of Pathology, Vrije Universiteit Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands;

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A sexually transmitted disease?

Cervical cancer continues to be a major health care problem worldwide. Over the past few decades, it has become more and more apparent that the human papillomavirus (HPV) is strongly associated with cervical cancer. Several other associations between infections with microorganisms and cancer have been described, such as Epstein-Barr virus (EBV) and gastric cancer,1 lymphoepithelioma-like cancer,2 and lymphomas3–10; Helicobacter pylori and gastric cancer11–18 and mucosa associated lymphoid tissue lymphoma19,20; and human herpesvirus 8 and Kaposi sarcoma.21–23 However, these associations are of a different strength. For example, H pylori is probably indirectly related to gastric cancer—it causes a chronic infection that may eventually lead to atrophy, intestinal metaplasia, dysplasia, and cancer. The relation between EBV and lymphoma is biologically stronger because EBV produces proteins with oncogenic properties. Real causal relations between microorganisms and cancer are difficult to prove. This requires many well designed studies providing evidence on this relation regarding: (1) strength, (2) consistency, (3) specificity, …

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