Background Infection with the human papillomavirus (HPV) hasbeen established as a cause of cervical cancer, but the associationbetween a positive test for HPV DNA and the risk of the subsequentdevelopment of invasive cervical cancer is unknown.
Methods In a study of women who participated in a population-basedscreening program for cancer of the cervix in Sweden from 1969to 1995, we compared the proportion of normal cervical smears(Pap smears) that were positive for HPV DNA among 118 womenin whom invasive cervical cancer developed an average of 5.6years later (range, 0.5 month to 26.2 years) with the proportionof HPV DNA–positive smears from 118 women who remainedhealthy during a similar length of follow-up (controls). Thecontrol women were matched for age to the women with cancer,and they had had two normal Pap smears obtained at time pointsthat were similar to the times of the base-line smear and thediagnosis of cancer confirmed by biopsy in the women with cancer.
Results At base line, 35 of the women with cancer (30 percent)and 3 of the control women (3 percent) were positive for HPVDNA (odds ratio, 16.4; 95 percent confidence interval, 4.4 to75.1). At the time of diagnosis, 80 of the 104 women with cancerfor whom tissue samples were available (77 percent) and 4 ofthe 104 matched control women (4 percent) were positive forHPV DNA. The HPV DNA type was the same in the base-line smearand the biopsy specimen in all of the women with cancer in whomHPV DNA was detected at base line. None of the control womenhad the same type of HPV in both smears.
Conclusions A single positive finding of HPV DNA in a Pap smearconfers an increased risk of future invasive cervical cancerthat is positive for the same type of virus.
Source Information
From the Laboratory of Tumor Virus Epidemiology, Microbiology and Tumor Biology Center, Karolinska Institute, Stockholm, Sweden (K.-L.W., J.D.); the Center for Oncology (F.W.), the Cytology Laboratory (T.Å.), the Department of Pathology (F.B.), the Department of Oncology, Section of Gynecology (U.S.), the Department of Virology (G.W.), and the Department of Public Health and Clinical Medicine, Medical Bank (G.H.), University Hospital of Northern Sweden, Umeå, Sweden; and the School of Public Health, University of Tampere, Tampere, Finland (J.D.).
Address reprint requests to Dr. Wallin at the Laboratory of Tumor Virus Epidemiology, Microbiology and Tumor Biology Center, Karolinska Institute, P.O. Box 280, S-171 77 Stockholm, Sweden, or at kengling{at}sec.se.
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