Papillomavirus-related genital neoplasia: present and future prevention

As our understanding of genital precancers has evolved, it has become clear that human papillomaviruses (HPV) are intimately related to the spectrum of precancerous change. Traditional approaches to removing these lesions have centered on destruction of the neoplastic epithelium and careful cytological follow up. This approach has met with success in preventing cancer, but has not addressed patients who present with invasive cancer whose precancer went undiscovered. With the realization that HPV is closely associated with precancers and invasive cancers of the female genital tract, efforts have centered on developing methodologies which would identify specific HPV types in high risk women or in the general population that might reduce the number of missed carcinomas. This approach, although attractive, has met with problems due to the high prevalence rate of HPV infections in general in the population and the knowledge that certain cofactors, either environmental or host related, play a part in selecting a subset of women who will eventually develop cancer. The impact of HPV screening on detecting and preventing the rarer forms of aggressive cancer, such as adenosquamous carcinoma and small cell carcinomas, is as yet unclear. The possibility that genital cancer may be prevented by a vaccine to HPV is supported by the identification of a host response to specific HPV products. Efforts are in progress to characterize the early and late gene products associated with HPV infection, identify the specific epitopes commonly recognized by the host, and initiate studies to determine the spectrum of the population displaying an immune response to these infections.(ABSTRACT TRUNCATED AT 250 WORDS)