Viral Load of Human Papilloma Virus 16 as a Determinant for Development of Cervical Carcinoma In Situ: A Nested Case-Control Study

Abstract

Lancet 2000;355:2189–93 Because less than 1% of young women positive for oncogenic types of human papillomavirus (HPV) develop cancer, these investigators determined whether the amount of HPV DNA is a useful predictor of progression to cervical carcinoma in situ (CIS). Using a PCR technique to identify HPV DNA in 478 women with cervical carcinoma in situ and 608 matched controls, 3,835 archived cervical smears were studied, with multiple smears available for each woman. Some samples were 26 years old. Analysis of the first smear from each woman, collected a mean of 7–8 years before the CIS diagnosis, showed that women with the 20% highest amount of HPV 16 DNA were at a 60-fold higher risk of developing CIS than women negative for HPV. The authors conclude that “the amount of HPV DNA can predict cancer risk when current screening methods are uninformative.” Comment: This study and a second one in the same issue of Lancet show that levels of HPV 16 DNA, and not just its presence or absence, confer a substantially increased risk of cervical cancer. Though way too expensive to use as a primary detection technique, this finding is certainly logical and parallels what is known about viral load and human immunodeficiency virus syndrome. (TMJ)