Human papillomaviruses and other biological markers in cervical cancer

The presence of HPV DNA in the genital tract and the genotype of the infecting HPV are now widely employed as biochemical markers in epidemiological studies of cervical cancer. Additional HPV markers could be utilized in future investigations. The amount of HPV DNA is likely to be higher in case specimens than in control specimens; viral genome would be integrated frequently in cases but almost never in controls; and early region transcripts may be relatively more abundant in cases than in controls. When valid serological markers for past HPV infection become available (very likely, antibodies to HPV capsid proteins), they will be useful to estimate lifetime exposure to HPVs. Serological markers for HPV-associated neoplasia (very likely, antibodies to early proteins) may prove useful for surveillance and have prognostic value. A serological marker capable of detecting past herpes simplex virus 2 infection would permit an analysis of the role of this virus in cervical cancer, either as an independent risk factor or in interaction with HPVs. Other possible biomarkers include activation of oncogenes and inactivation of tumour-suppressor genes, assays for serum micronutrients, and analysis of leukocytes for HLA antigens; these should provide insights into the sequence of events that lead to cervical cancer and help to explain the geographic distribution of the disease.