CiteWeb id: 19990000042

CiteWeb score: 7191

DOI: 10.1002/(SICI)1096-9896(199909)189:1

A recent report that 93% of invasive cervical cancers worldwide contain human papillomavirus (HPV) may be an underestimate due to sample inadequacy or integration of events affecting the HPV L1 gene which is the target of the polymerase chain reaction (PCR)-based test which was used. The formerly HPV-negative cases from this study have therefore been reanalyzed for HPV serum antibodies and HPV DNA. Serology for HPV 16 virus-like particles E6 and E7 antibodies was performed on 49 of the 66 cases which were HPV-negative and a sample of 48 of the 866 cases which were HPV-positive in the original study. Moreover 55 of the 66 formerly HPV-negative biopsies were also reanalyzed by a sandwich procedure in which the outer sections in a series of sections are used for histological review while the inner sections are assayed by three different HPV PCR assays targeting different open reading frames. No significant difference was found in serology for HPV 16 proteins between the cases that were originally HPV PCR-negative and -positive. Type-specific E7 PCR for 14 high-risk HPV types detected HPV DNA in 38 (69%) of the 55 originally HPV-negative and amplifiable specimens. The HPV types detected were 16 18 31 33 39 45 52 and 58. Two (4%) additional cases were only HPV DNA-positive by E1 and/or L1 consensus PCR. Histological analysis of the 55 specimens revealed that 21 were qualitatively inadequate. Only 2 of the 34 adequate samples were HPV-negative on all PCR tests as opposed to 13 of the 21 that were inadequate (p < 0.001). Combining the data from this and the previous study and excluding inadequate specimens the worldwide HPV prevalence in cervical carcinomas is 99.7%. The presence of HPV in virtually all cervical cancers implies the highest worldwide attributable fraction so far reported for a specific cause of any major human cancer. The extreme rarity of HPV-negative cancers reinforces the rationale for HPV testing in addition to or even instead of cervical cytology in routine cervical screening. (authors)

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