Human papillomavirus and cervical neoplasia: epidemiological considerations

Recent clinical research using new diagnostic and laboratory techniques indicates that human papillomavirus (HPV) infection may play a key role in the development of cervical neoplasia. Cervical HPV infection is found in 1-3% of routine Papanicolaou smears, and preliminary data suggest that women with cervical HPV infection have about a tenfold greater risk of developing cervical intraepithelial neoplasia (CIN) compared with those with no HPV infection. This paper discusses how epidemiological studies can reduce misclassification of cervical HPV infection and CIN through selective use of research advances in cytologic, histologic and colposcopic techniques. These studies can also assess whether certain potential cocarcinogens interact synergistically with HPV. Since an estimated 2-10% of women with cervical HPV lesions develop associated CIN within a year, it appears feasible to conduct prospective studies of the risk of malignant transformation of cervical HPV lesions.