Periodic health examination, 1995 update: 1. Screening for human papillomavirus infection in asymptomatic women

Table 1: Evidence of association between HPV infection and cervical cancer

Study Type of Study Patient population Results

Koutsky et al, United States, 1992[9] Prospective cohort study 241 women at an STD clinic 28% of HPV-positive women and 3% of HPV-negative women had grade 2 or 3 CIN; relative risk (RR) = 11 for HPV-positive women in relation to HPV-negative women

Reeves et al, Latin America, 1989[10] Case-control study 759 women with invasive cervical cancer; 1467 control subjects Odds ratio (OR) for cervical cancer was 2.9 to 9.1 according to strength of DNA hybridization reaction

Schiffman et al, United States, 1993[11] Case-control study 500 women with CIN (grades 1 through 3); control subjects were 500 women with normal cytologic test results 76% of cases of CIN (90% and 88% of grade 2 and 3 CIN respectively) attributed to HPV infection

De Villiers et al, Germany, 1987[24] Cross-sectional study 9295 women at outpatient gynecology clinics HPV rate 5% to 10% among women with normal Papanicolaou smears, 35% to 40% among those with CIN or cervical cancer

Van de Brule et al, the Netherlands, 1991[29] Prevalence survey 1346 asymptomatic women, 593 gynecologic outpatients HPV rates for those with normal Papanicolaou smears were 3.5% among asymptomatic women and 14% among outpatients; HPV rates for those with abnormal smears were 70% among women with mild dysplasia, 84% among those with severe dysplasia and 100% among those with CIN

Ritter et al, United States, 1988[39] Survey 191 women at hospital colposcopy clinic OR 11.8 for CIN or cancer among HPV-positive women

Rader et al, United States, 1991[40] Case series 30 women with atypical Papanicolaou smears, normal smears or CIN HPV rate 17% among those with normal smears, 33% among those with atypical smears and 59% among those with CIN

Mitchell et al, Australia Cohort study 846 women with HPV infection alone on Papanicolaou smear Cancer in situ in 3.5% of patients after 6yr follow-up; RR = 15.6 relative to population incidence figures

Campion et al, Britain, 1986[42] Cohort study 100 women with signs of mild atypia on Papanicolaou smear and colposcopy HPV-16 found in 39% overall and in 85% of those showing signs of progression to grade 3 CIN

Borst et al, United States, 1991[44] Cross-sectional study with concurrent control subjects 50 women referred with atypia but not dysplasia on Papanicolaou smear HPV rate 46% among patients with abnormal smears and among those with CIN, 11.6% among those with normal smears; HPV-16 DNA screen not predictive of CIN

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Table 1: Evidence of association between HPV infection and cervical cancer
Study	Type of Study	Patient population	Results
Koutsky et al, United States, 1992[9]	Prospective cohort study	241 women at an STD clinic	28% of HPV-positive women and 3% of HPV-negative women had grade 2 or 3 CIN; relative risk (RR) = 11 for HPV-positive women in relation to HPV-negative women
Reeves et al, Latin America, 1989[10]	Case-control study	759 women with invasive cervical cancer; 1467 control subjects	Odds ratio (OR) for cervical cancer was 2.9 to 9.1 according to strength of DNA hybridization reaction
Schiffman et al, United States, 1993[11]	Case-control study	500 women with CIN (grades 1 through 3); control subjects were 500 women with normal cytologic test results	76% of cases of CIN (90% and 88% of grade 2 and 3 CIN respectively) attributed to HPV infection
De Villiers et al, Germany, 1987[24]	Cross-sectional study	9295 women at outpatient gynecology clinics	HPV rate 5% to 10% among women with normal Papanicolaou smears, 35% to 40% among those with CIN or cervical cancer
Van de Brule et al, the Netherlands, 1991[29]	Prevalence survey	1346 asymptomatic women, 593 gynecologic outpatients	HPV rates for those with normal Papanicolaou smears were 3.5% among asymptomatic women and 14% among outpatients; HPV rates for those with abnormal smears were 70% among women with mild dysplasia, 84% among those with severe dysplasia and 100% among those with CIN
Ritter et al, United States, 1988[39]	Survey	191 women at hospital colposcopy clinic	OR 11.8 for CIN or cancer among HPV-positive women
Rader et al, United States, 1991[40]	Case series	30 women with atypical Papanicolaou smears, normal smears or CIN	HPV rate 17% among those with normal smears, 33% among those with atypical smears and 59% among those with CIN
Mitchell et al, Australia	Cohort study	846 women with HPV infection alone on Papanicolaou smear	Cancer in situ in 3.5% of patients after 6yr follow-up; RR = 15.6 relative to population incidence figures
Campion et al, Britain, 1986[42]	Cohort study	100 women with signs of mild atypia on Papanicolaou smear and colposcopy	HPV-16 found in 39% overall and in 85% of those showing signs of progression to grade 3 CIN
Borst et al, United States, 1991[44]	Cross-sectional study with concurrent control subjects	50 women referred with atypia but not dysplasia on Papanicolaou smear	HPV rate 46% among patients with abnormal smears and among those with CIN, 11.6% among those with normal smears; HPV-16 DNA screen not predictive of CIN