Bosch F Xavier, Muñoz Nubia
Institut Català d'Oncologia, Servei d'Epidemiologia i Registre del Càncer, Hospital Duran i Reynals, Gran Via km 2,7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Virus Res. 2002 Nov;89(2):183-90. doi: 10.1016/s0168-1702(02)00187-9.
Epidemiological studies supported by molecular technology have provided sufficient evidence on the causal role of some Human Papillomavirus (HPV) infections in the development of cervical cancer. This association has been evaluated under all proposed sets of causality criteria and endorsed by the scientific community and major review institutes. HPV has been proposed as the first-ever identified, necessary cause of a human cancer. In practical terms, the concept of a necessary cause implies that cervical cancer does not and will not develop in the absence of the persistent presence of HPV-deoxyribonucleic acid (DNA). This important advancement has two practical implications in prevention. Firstly, screening programs can be enhanced if HPV testing is judiciously incorporated into solving the fraction of ambiguous cytology readings. In some populations HPV screening as a primary test may prove to be the strategy of choice. Secondly, like in the hepatitis B disease model, intense efforts are currently being put into the development and testing of vaccines that may prevent the relevant HPV infections, and presumably, cervical cancer. At this stage of development, regulatory agencies are requested to evaluate the scientific evidence and weigh its implications in relation to costs, public health investments and policy. This is a subjective evaluation that could be guided by a careful description of the most relevant studies and findings.
分子技术支持的流行病学研究已为某些人乳头瘤病毒（HPV）感染在宫颈癌发生中的因果作用提供了充分证据。这种关联已根据所有提出的因果关系标准进行了评估，并得到了科学界和主要评审机构的认可。HPV已被提议作为人类癌症中首个被确定的必要病因。实际上，必要病因的概念意味着在没有HPV脱氧核糖核酸（DNA）持续存在的情况下，宫颈癌不会也不会发生。这一重要进展在预防方面有两个实际意义。首先，如果明智地将HPV检测纳入解决部分模糊的细胞学检查结果中，筛查项目可以得到加强。在某些人群中，HPV筛查作为主要检测方法可能被证明是首选策略。其次，就像在乙肝疾病模型中一样，目前正在大力研发和测试可能预防相关HPV感染以及推测预防宫颈癌的疫苗。在这个发展阶段，要求监管机构评估科学证据，并权衡其在成本、公共卫生投资和政策方面的影响。这是一项主观评估，可能需要对最相关的研究和发现进行仔细描述来指导。
