American Journal of Epidemiology Advance Access originally published online on May 15, 2008
American Journal of Epidemiology 2008 168(2):138-144; doi:10.1093/aje/kwn037
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Invited Commentary: Is Monitoring of Human Papillomavirus Infection for Viral Persistence Ready for Use in Cervical Cancer Screening?
From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
Correspondence to Dr. Philip E. Castle, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd., EPS Room 5004, MSC 7234, Bethesda, MD 20892-7234 (e-mail: castlep{at}mail.nih.gov).
Received for publication November 28, 2007. Accepted for publication January 17, 2008.
Persistent cervical infections by approximately 15 carcinogenic genotypes of human papillomavirus (HPV) cause virtually all cases of cervical cancer and its immediate precancerous precursor, cervical intraepithelial neoplasia grade 3 or carcinoma in situ. As is shown in a meta-analysis by Koshiol et al. (Am J Epidemiol 2008;168:123–137), detection of carcinogenic HPV viral persistence could be used to identify women at the greatest risk of cervical precancer. Specifically, women who have carcinogenic HPV infection that persists for at least 1 year versus those whose infections clear are at significantly elevated risk of having or developing cervical precancer. However, before detection of HPV persistence can be used in cervical cancer screening, several considerations need to be addressed: 1) validation and Food and Drug Administration approval of a reliable HPV genotyping test, 2) rational clinical algorithms based on risk of precancer and cancer for the clinical management of HPV persistence, 3) clinician and patient acceptability of monitoring of HPV infections (including not responding excessively to the first positive HPV test and waiting 1–2 years for infections to either persist or resolve), and 4) patient compliance with recommended follow-up. Investigators will need to address these and other key issues in order to realize the potential utility of HPV viral monitoring for improving the accuracy of cervical cancer screening.
human papillomavirus 16; human papillomavirus 18; longitudinal studies; papillomavirus infections; uterine cervical neoplasms
Abbreviations: CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus; HSIL, high-grade squamous intraepithelial lesions
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Related articles in Am. J. Epidemiol.:
- Persistent Human Papillomavirus Infection and Cervical Neoplasia: A Systematic Review and Meta-Analysis
- Jill Koshiol, Lisa Lindsay, Jeanne M. Pimenta, Charles Poole, David Jenkins, and Jennifer S. Smith
Am. J. Epidemiol. 2008 168: 123-137.[Abstract] [FREE Full Text]
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  P. E. Castle, C. Porras, W. G. Quint, A. C. Rodriguez, M. Schiffman, P. E. Gravitt, P. Gonzalez, H. A. Katki, S. Silva, E. Freer, et al. Comparison of Two PCR-Based Human Papillomavirus Genotyping Methods J. Clin. Microbiol., October 1, 2008; 46(10): 3437 - 3445. [Abstract] [Full Text] [PDF]
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 J. Koshiol, C. Poole, H. Chu, J. M. Pimenta, L. Lindsay, D. Jenkins, and J. S. Smith The Authors Respond to "HPV Persistence and Cervical Cancer Screening" Am. J. Epidemiol., July 15, 2008; 168(2): 145 - 148. [Full Text] [PDF]
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