HPV genotypes: implications for worldwide cervical cancer screening and vaccination.

摘要

In the Lancet Oncology today, Silvia de Sanjose and colleagues report the results of an international prevalence survey about the human papillomavirus (HPV) type-specific burden of cervical cancer worldwide. The study included more than 10000 histologically confirmed cases of invasive cervical cancer from 38 countries. Samples were pooled from large geographical regions and the number of institutions contributing cases was variable. For example, Australia represented all of Oceania (n=170 HPV-positive cases), and the USA represented all of North America (n=160 HPV-positive cases), with only one or two institutions, respectively, providing cases. Thus, some regional-specific and country-specific HPV prevalence estimates were limited and should not be considered in isolation. The overall detection of any HPV genotype (85%) was inconsistent with the idea that virtually all cases of invasive cervical cancer are due to HPV infections. As in previous studies, HPV-negative cases were probably caused by artifacts. Possible factors contributing to HPV-negative cases included tissue inadequacy, nucleic-acid degradation in formalin-fixed tissues, low viral loads, and potential misdiagnosis, partly because of an apparent absence of staging data and of stains to exclude samples of endometrial origin. Although a minor fraction of invasive cervical cancer might still arise independent of HPV, studies of fresh-frozen cancer tissues suggest that this is only a small percentage of all invasive cancers.