Targeting the human papillomavirus for prevention of cervical cancer

Pontus Naucler

Research output: ThesisDoctoral Thesis (compilation)

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Different types of human papillomavirus (HPV) vary in the extent they cause precursor lesions (CIN) and cancer. There are limited long-term efficacy data on HPV testing in primary screening

Among 72 cervical cancers in Mozambique, HPV 16 and 18 were the most frequent HPV types (69% of cases). Comparing 108 cervical cancers cases and 517 matched controls nested within a population-based cohort in Taiwan, HPV 16 seropositivity implied a 6-fold increased cancer risk. In a cohort of 5696 women in Sweden, HPV types 16, 31 and 33 conveyed the highest risks for future high-grade CIN (CIN 2+), attributing to 33.1%, 18.3% and 7.7% of CIN 2+ cases, respectively. In a pooled analysis of seven European longitudinal studies of HPV-based cervical screening, the cumulative incidence rate of CIN grade 3 or worse (CIN 3+) was higher after 3 years among women with normal cytology than among women with a negative HPV test after 6 years. Finally, in a randomized cervical cancer screening trial in Sweden, adding testing for HPV persistence resulted in a 51% (95% CI: 13-102) increase of CIN 2+ at prevalent screening, which was followed by a reduction of 42% (95% CI: 4-76) of CIN 2+ at incident screening.

In conclusion, HPV-based cervical cancer screening protects against future CIN 2+, and the long-term protective effect should enable extended screening intervals to 6 years. Albeit HPV 16 is the most important carcinogenic HPV type all over the world, different ?high-risk? HPV types convey distinctly different risks for CIN 2+, which should be considered in design of screening tests and vaccines.
Original languageEnglish
Awarding Institution
  • Clinical Microbiology, Malmö
  • Dillner, Joakim, Supervisor
Award date2007 Jun 14
ISBN (Print)978-91-85559-75-6
Publication statusPublished - 2007

Bibliographical note

Defence details

Date: 2007-06-14
Time: 13:00
Place: Föreläsningssalen Patologen, ingång 78, UMAS

External reviewer(s)

Name: Peto, Julian
Title: Professor
Affiliation: London School of Hygiene and Tropical Medicine, London, UK


<div class="article_info">P Naucler, F Mabota da Costa, O Ljungberg, A Bugalho and J Dillner. <span class="article_issue_date">2004</span>. <span class="article_title">Human Papillomavirus genotypes in Cervical Cancers in Mozambique.</span> <span class="journal_series_title">J Gen Virol.</span>, <span class="journal_volume">vol 85</span> <span class="journal_pages">pp 2189-90</span>.</div>
<div class="article_info">P Naucler, H-C Chen, K Persson, S-L You, C-Y Hsieh, C-A Sun, J Dillner and C-J Chen. <span class="article_issue_date">2007</span>. <span class="article_title">Seroprevalence of Human Papillomaviruses, Chlamydia trachomatis and cervical cancer risk: nested case-control study.</span> <span class="journal_series_title">J Gen Virol.</span>, <span class="journal_volume">vol 88</span> <span class="journal_pages">pp 814-22</span>.</div>
<div class="article_info">P Naucler, W Ryd, S Törnberg, A Strand, G Wadell, B-G Hansson, E Rylander and J Dillner. <span class="article_issue_date"></span>. <span class="article_title">HPV type-specific risks of high grade CIN during 4 years of follow-up: A population-based prospective study.</span> (submitted)</div>
<div class="article_info">J Dillner, M Rebolj, P Birembaut, K-U Petry, A Szarewski, C Munk, S de Sanjose, P Naucler, B Lloveras, S Kjaer, J Cuzick, M van Ballegooijen, C Clavel and T Iftner. <span class="article_issue_date"></span>. <span class="article_title">Joint European Study on the Long-Term Predictive Values for Cervical Intraepithelial Neoplasia Grade 3 of Cytology and HPV DNA testing.</span> (manuscript)</div>
<div class="article_info">P Naucler, W Ryd, S Törnberg, A Strand, G Wadell, K Elfgren, T Rådberg, B Strander, O Forslund, B-G Hansson, E Rylander and J Dillner. <span class="article_issue_date"></span>. <span class="article_title">Long-term efficacy of HPV testing in primary cervical cancer screening among middle-aged women: Randomized controlled trial.</span> (manuscript)</div>

Subject classification (UKÄ)

  • Microbiology in the medical area


  • bakteriologi
  • virologi
  • Mikrobiologi
  • mycology
  • virology
  • bacteriology
  • prevention
  • Microbiology
  • CIN
  • vaccine
  • cervical intraepithelial neoplasia
  • screening
  • cervical cancer
  • Human Papillomavirus
  • HPV
  • mykologi
  • Public health
  • epidemiology
  • Folkhälsa
  • epidemiologi


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