Ashley's hypothesis revisited

Nowadays it is widely accepted that cervical cancer is a virus related, sexually transmitted disease, but no complete agreement exists about its etiological factors. They may be identified in HSV or in HPV or in both. Moreover, its is accepted that cervical cancer does not arises ex abrupto from normal epithelium, but often arises from the epithelia with well codified morphological lesions now defined as "Cytohistological Cervical Cancer Precursors". Epidemiological data available at the moment, also concerning risk age, suggest that two different risk classes do exist. They range respectively between 20 and 40 years and between 50 and 70 years of age. When considering sexual promiscuity, younger patients refer a higher and more intensive level than that referred by older; the latter often claim for a low level of sexual activity. Starting from this observation, as well as from clinical and histological evidence, Ashley first suggested in 1965 the existence of two different types of cervical cancer. In the Ashley hypothesis the first type, slow-growing, is often preceded by a precursor, non-invasive stage, while the second, fast-growing, rapidly invades, often without evidence of a previnvasive stage. In our series of 1,010 invasive and 210 in situ cervical cancers, indeed, two different ranges of risk-ages exist, fulfilling Ashley's hypothesis. Morphological evaluation of lesions shows that in the younger patients, invasive cancer is, in a high percentage, associated with HPV-VCE and CIN in the surroundings, while in the older, this feature is less evident.(ABSTRACT TRUNCATED AT 250 WORDS)