Neoplasia: Implications for Current Views and Treatment

Over the last decade there has been a steady accumulation of data supporting the hypothesis that specific types of human papillomaviruses (HPVs) play a central role in the pathogenesis of invasive cervical cancer and the presumed precursor lesions of invasive cervical cancer (/). Such lesions are termed "cervical intraepithelial neoplasia " (CIN) and are graded, according to their presumed likelihood of progression to invasive cancer, as CIN 1, CIN 2, and CIN 3 (2). The study by Schiffman et al. (5) reported in this issue of the Journal strengthens previous observations about the relationship between HPV and all grades of CIN. By using HPV DNA assays that are considerably more sensitive and that are able to detect a wider spectrum of HPV types than assays used in many previous studies, and by focusing on the relationship between HPV and factors traditionally associated with an increased risk of CIN, this study provides further evidence that HPV is the causal agent of most CIN lesions. As Schiffman et al. point out, the association between HPV infection and CIN now satisfies accepted criteria for assessing causality from epidemiologic studies. Furthermore, studies show that infection with one or more of a larg