Viral etiology of cervical cancer: a critique of the evidence.

Cancer of the uterine cervix is one of the most common malignant diseases worldwide. Although morbidity rates have declined in the past several decades as a consequence of wide-scale screening, the disease remains an important public health problem. The risk of cervical cancer is strongly influenced by sexual behavior, which suggests a causal role for an infectious agent. Certain types of human papillomaviruses (HPVs) seem to be involved in the genesis of the disease. In addition, there is good evidence that herpes simplex viruses may also be implicated. Recently, important epidemiological incoherences have been found with respect to the sexual transmission route of HPV infection in the causal pathway of cervical cancer. HPV infection rates in asymptomatic women do not seem to be related to sexual behavior, and if analyzed simultaneously sexual behavior and HPV infection seem to be independent predictors of cervical cancer risk. If confirmed by further research, these findings could signify that there may be alternative etiologic mechanisms for cervical cancer. Since some researchers have recently proposed public health action because of the acceptance of HPV infection as a necessary cause of cervical cancer, it is imperative that the aforementioned incoherences be immediately resolved by further research.