Human papillomavirus in cervical cancer.

Epidemiologic studies supported by molecular technology have provided sufficient evidence of the causal role of some human papillomavirus (HPV) infections in the development of cervical cancer. The finding is consistent universally, and HPV has been proposed as the first identified necessary cause of cervical cancer. Such recognition translates into the concept that cervical cancer does not develop without persistent presence of HPV DNA. In the developed parts of the world, cytologic screening programs could benefit from the addition of HPV testing to their protocols. Controlled studies and one randomized trial have shown that HPV testing is helpful in solving the ambiguous cases generated by cytology reading. In populations where cytology programs are not functional or efficient, HPV testing is being evaluated as an alternative means of primary screening. Prevention of exposure to high-risk HPV types, either by prophylactic vaccination or by combined prophylactic and therapeutic immunologic intervention, may prove to be the most efficient and logistically feasible option for the prevention of cervical cancer in developing populations.