HPV DNA AND THE RISK OF SQUAMOUS INTRAEPITHELIAL LESIONS OF THE UTERINE CERVIX IN YOUNG-WOMEN

A population-based case-control study of college students was undertak en to estimate the effect of a positive clinical test for human papill omavirus (HPV) DNA (the Virapap test) on the rate of squamous intraepi thelial lesions (SIL) of the uterine cervix. When age, multiple lifeti me sexual partners, and oral contraceptive use were controlled by logi stic regression, the adjusted odds ratio (OR) for a positive Virapap t est was 7.3 (3.3,17) for a cytologic diagnosis of SILs and 3.4 (1.4,8. 5) for a cytologic diagnosis of squamous intraepithelial lesions of un determined significance (equivocal atypia). When case status was defin ed as patients whose Pap smears were confirmed histologically as high- grade SIL, the adjusted OR was 10.3 (3.3, 32), reflecting the high pro portion of individuals with SILs who were harboring high-grade squamou s intraepithelial lesiOns. These results confirm the many previous fin dings of a strong association between HPV DNA, and demonstrate that st rength of the association persists when important confounding variable s are controlled. This suggests a causal role for HPV in cervical neog enesis. Believing that HPV infection is a major causal agent for cervi cal cancer precursors suggests that in this time of rapidly increasing HPV prevalence, especially among young persons, the incidence of cerv ical neoplasia will rise. This underscores the importance of increasin g the availability, usage, and perhaps the frequency of Pap smear scre ening.