Is human papillomavirus an infectious cause of non-cervical anogenital tract cancers?BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7109.620 (Published 13 September 1997) Cite this as: BMJ 1997;315:620
- Howard D Strickler, Senior clinical investigatora,
- Mark H Schiffman, Chief interdisciplinary studies sectionb
- a Viral Epidemiology Branch
- b Environmental Epidemiology Branch, National Cancer Institute, Bethesda, Md 20892, USA
Results from a large study provide strong epidemiological evidence
“Temporality” is a central tenet in the epidemiological assessment of causality, requiring that exposure to a putative cause must precede development of the disease.1 However, temporality has been difficult to demonstrate in the study of human papillomavirus infection as a cause of non-cervical anogenital tract tumours.
In cervical cancers human papillomavirus DNA can be detected in over 90% of lesions. Moreover, cervical human papillomavirus has been detected before the development of cervical intraepithelial neoplasia, which is well established to be a precursor of cancer.2 In non-cervical anogenital tumours a common causal relation with human papillomavirus is suggested by the raised risk of anal, vulvar, and vaginal tumours after cervical cancer3; a high prevalence of penile intraepithelial neoplasia in the sexual partners of women with cervical intraepithelial neoplasia4; and the high prevalence of human papillomavirus DNA in non-cervical anogenital cancer tissues.5 Infection of …