Natural History of HPV Infections: Recent Developments

摘要

To elucidate the natural history of cervical cancer and its precursors, a prospective cohort study is mandatory, in which a cohort of women with cancer precursor (CIN) lesions is being prospectively followed-up without any therapeutic intervention for an extended period of time (i.e. many years). In the world literature, a substantial number of such prospective cohort studies are reported, several of them already long before the start of the "HPV era" from the late 1970's. Several conceptual problems are encountered in these natural history studies conducted during the past several decades (to be discussed). Most importantly, we must accept the fact that progression of any lesion to CIN III should be considered as a surrogate marker of progression to invasive disease, because continuation of the follow-up beyond CIN III is unethical.