PERSISTENCE OF HUMAN PAPILLOMAVIRUS (HPV) INFECTIONS PRECEDING CERVICAL-CARCINOMA

BACKGROUND. A persistent genital infection with an oncogene-type of hu man papillomavirus (HPV) is considered to be essential for the develop ment of most cervical carcinomas. Therefore, HPV analysis has been pro posed as a possible complementary cytological screening program. The a uthors have developed a technique to analyze archival Pap smears, whic h has enabled them to study the relation between persistent HPV infect ion and the development of cervical cancer. METHODS. Nested polymerase chain reaction was used to demonstrate the presence of HPV DNA, and s equencing of the obtained amplimer was performed to establish HPV type . The authors analyzed a series of 88 smears taken 1.5 to 7 years prio r to the diagnosis of an HPV-containing cervical carcinoma (12 invasiv e adenocarcinomas, 18 invasive squamous carcinomas, and 58 squamous ca rcinoma in situ), which were compared with age-matched controls with n o tumor development. RESULTS. HPV DNA was present in a majority of the smears preceding a cancer, with an odds ratio of around 15 for all tu mor groups. Infections with a persisting HPV type were demonstrated in most samples from a series of eight patients, from who multiple smear s were available, covering the 7-year period preceeding the cancer dia gnosis. CONCLUSIONS. Persisting infection can be demonstrated in exfol iated cells many years before cancer is diagnosed. The results are com plementary to those obtained with cytology, that is, HPV is detected a lso in those at-risk patients whose Pap smears are morphologically nor mal. However, the results are still insufficient to justify a general recommendation to use HPV testing for health control purposes. (C) 199 6 American Cancer Society.