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. 2001 Apr 3;164(7):1017-25.

Cervical cancer: epidemiology, prevention and the role of human papillomavirus infection

E L Franco  1 , E Duarte-Franco, A Ferenczy
Affiliations

Cervical cancer: epidemiology, prevention and the role of human papillomavirus infection

E L Franco et al. CMAJ. .

Abstract

Organized screening has contributed to a decline in cervical cancer incidence and mortality over the past 50 years. However, women in developing countries are yet to profit extensively from the benefits of screening programs, and recent trends show a resurgence of the disease in developed countries. The past 2 decades have witnessed substantial progress in our understanding of the natural history of cervical cancer and in major treatment advances. Human papillomavirus (HPV) infection is now recognized as the main cause of cervical cancer, the role of coexisting factors is better understood, a new cytology reporting terminology has improved diagnosis and management of precursor lesions, and specific treatment protocols have increased survival among patients with early or advanced disease. Current research has focused on the determinants of infection with oncogenic HPV types, the assessment of prophylactic and therapeutic vaccines and the development of screening strategies incorporating HPV testing and other methods as adjunct to cytology. These are fundamental stepping stones for the implementation of effective public health programs aimed at the control of cervical cancer.

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Figures

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Fig. 1: Annual incidence and mortality rates (per 100 000 women) of invasive cervical cancer in Canada, the United States and cancer surveillance regions of theWorld Health Organization. Rates are standardized according to age distribution of world population in 1960. Source: Ferlay et al.
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Fig. 2: Annual incidence and mortality rates (per 100 000 women) of invasive cervical cancer in Canada. Rates are standardized according to age distribution of Canadian population in 1991. Source: Cancer Bureau, Population and Public Health Branch, Health Canada.
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Fig. 3: Annual incidence rates (per 100 000 women) of invasive cervical cancer among women less than 50 years of age and among those 50 years or older in Canada (solid line) and in the United States (broken line). Rates are standardized according to age distribution of Canadian population in 1991. Source: Cancer Bureau, Population and Public Health Branch, Health Canada, and the National Cancer Institute Statistics, Epidemiology, and End Results (SEER) program.
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Fig. 4: Etiological model of human papillomavirus (HPV) infection and cervical cancer, illustrating probable role of remote behavioural risk factors for persistent infection and of coexisting factors that mediate lesion progression. Photo by: Lianne Friesen
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References

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