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Previous Volume 348:518-527 February 6, 2003 Number 6 Next

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ABSTRACT

Background Infection with human papilloma virus (HPV) is the main cause of cervical cancer, but the risk associated with the various HPV types has not been adequately assessed.

Methods We pooled data from 11 case–control studies from nine countries involving 1918 women with histologically confirmed squamous-cell cervical cancer and 1928 control women. A common protocol and questionnaire were used. Information on risk factors was obtained by personal interviews, and cervical cells were collected for detection of HPV DNA and typing in a central laboratory by polymerase-chain-reaction–based assays (with MY09/MY11 and GP5+/6+ primers).

Results HPV DNA was detected in 1739 of the 1918 patients with cervical cancer (90.7 percent) and in 259 of the 1928 control women (13.4 percent). With the GP5+/6+ primer, HPV DNA was detected in 96.6 percent of the patients and 15.6 percent of the controls. The most common HPV types in patients, in descending order of frequency, were types 16, 18, 45, 31, 33, 52, 58, and 35. Among control women, types 16, 18, 45, 31, 6, 58, 35, and 33 were the most common. For studies using the GP5+/6+ primer, the pooled odds ratio for cervical cancer associated with the presence of any HPV was 158.2 (95 percent confidence interval, 113.4 to 220.6). The odds ratios were over 45 for the most common and least common HPV types. Fifteen HPV types were classified as high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82); 3 were classified as probable high-risk types (26, 53, and 66); and 12 were classified as low-risk types (6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP6108). There was good agreement between our epidemiologic classification and the classification based on phylogenetic grouping.

Conclusions In addition to HPV types 16 and 18, types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 should be considered carcinogenic, or high-risk, types, and types 26, 53, and 66 should be considered probably carcinogenic.

Source Information

From the International Agency for Research on Cancer, Lyons, France (N.M.); the Epidemiology and Cancer Registration Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain (F.X.B., S.S., X.C.); Costa Rican Foundation for Health Sciences, San José, Costa Rica (R.H.); the Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, Baltimore (K.V.S.); and the Department of Pathology, Vrije Universiteit Medical Center, Amsterdam (P.J.F.S., C.J.L.M.M.).

Address reprint requests to Dr. Muñoz at the Servei d'Epidemiologia i Registre del Càncer, Institut Català d'Oncologia, Hospital Duran i Reynals, Av. Gran Via, s/n km. 2,7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain, or at cris{at}ico.scs.es.

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Classification of Human Papillomavirus
Meyer T., Stockfleth E., Muñoz N., Bosch F. X., Snijders P. J.F.
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N Engl J Med 2003; 348:2040-2041, May 15, 2003. Correspondence

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