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BMJ No 7109 Volume 315 Papers - Abstracts Saturday 13 September 1997 Prospective seroepidemiological study of role of human papillomavirus in non-cervical anogenital cancers Tone Bjorge, Joakim Dillner, Tarja Anttila, Anders Engeland, Timo Hakulinen, Egil Jellum, Matti Lehtinen, Tapio Luostarinen, Jorma Paavonen, Eero Pukkala, Martin Sapp, John Schiller, Linda Youngman, Steinar Thoresen Abstract Objective: To evaluate the association between infection with the major oncogenic types of human papillomavirus and the risk of developing non-cervical anogenital cancers in a cohort followed up prospectively. Design: Data from two large serum banks to which about 700 000 people had donated serum samples were followed up for a mean of 8 years. People who developed non-cervical anogenital cancers during follow up were identified by registry linkage with the nationwide cancer registries in Finland and Norway. Within this cohort a nested case-control study was conducted based on the serological diagnosis of infection with human papillomavirus types 16, 18, and 33. Subjects: 81 cases and 240 controls matched for sex, age, and storage time of serum samples. Main outcome measures: Odds ratios of developing non-cervical anogenital cancers in presence of IgG antibodies to specific micro-organisms. Results: Subjects seropositive for human papillomavirus type 16 had an increased risk of developing non-cervical anogenital cancers (odds ratio 3.1 (95% confidence interval 1.4 to 6.9)). Subjects seropositive for type 33 also had an increased risk (odds ratio 2.8 (1.0 to 8.3)) but not significantly after adjustment for infection with type 16. Seropositivity for human papillomavirus type 16 was associated with an increased risk of developing vulvar and vaginal cancers (odds ratio 4.5 (1.1 to 22)) and a strongly increased risk of developing preinvasive vulvar and vaginal lesions (odds ratio |My (3.8 to |My)). Seropositivity for human papillomavirus type 18 increased the risk of developing preinvasive lesions (odds ratio 12 (1.2 to 590)). High, but non-significant odds ratios for types 16 and 33 were seen for penile cancers. Conclusions: This study provides prospective seroepidemiological evidence that infection with human papillomavirus type 16 confers an increased risk of developing non-cervical genital cancers, particularly vulvar and vaginal cancers. See editorial by Strickler and Schiffman Cancer Registry of Norway, Institute for Epidemiological Cancer Research, Montebello, N-0310 Oslo, Norway Tone Bjorge, research fellow Anders Engeland, statistician Steinar Thoresen, project manager, Norwegian mass screening programmes Microbiology and Tumourbiology Centre, Karolinska Institute, S-17177 Stockholm, Sweden Joakim Dillner, principal investigator National Public Health Institute, FIN-90101 Oulu, Finland Tarja Anttila, researcher Department of Cancer Epidemiology, Karolinska Institute, S-17177 Stockholm Timo Hakulinen, professor Janus Committee, Norwegian Cancer Society, N-0369 Oslo Egil Jellum, professor Department of Infectious Disease Epidemiology, National Public Health Institute, FIN-00300 Helsinki, Finland Matti Lehtinen, senior research fellow Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, FIN-00170 Helsinki Tapio Luostarinen, statistician Department of Obstetrics and Gynecology, Helsinki University Hospital, FIN-00290 Helsinki Jorma Paavonen, associate professor Tampere School of Public Health, University of Tampere, FIN-33101 Tampere, Finland Eero Pukkala, researcher Department of Medical Microbiology, University of Mainz, 55101 Mainz, Germany Martin Sapp, assistant professor Laboratory of Cellular Oncology, National Cancer Institute, Bethesda, MA 20892, USA John Schiller, senior investigator Clinical Trials Service Unit, University of Oxford, Oxford OX2 6HE Linda Youngman, senior research fellow Correspondence to: Dr Bjorge (tb@kreftreg.no) Home | Current contents | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline