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Review
. 2013 Apr;22(4):553-60.
doi: 10.1158/1055-9965.EPI-12-1406.

Human papillomavirus infection and the multistage carcinogenesis of cervical cancer

Mark Schiffman  1 , Nicolas Wentzensen
Affiliations
Review

Human papillomavirus infection and the multistage carcinogenesis of cervical cancer

Mark Schiffman et al. Cancer Epidemiol Biomarkers Prev. 2013 Apr.

Abstract

This short review outlines our understanding of cervical cancer precursors, concentrating on the central etiologic role of persistent human papillomavirus infection. The stages of cervical carcinogenesis are better understood than for most other major cancers, providing a successful cancer etiology and prevention model.

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Figures

Figure 1
Figure 1
Cervical cancer natural history model
Figure 2
Figure 2
Terminology of cervical disease categories The figure shows histological and cytological terminologies of cervical disease categories. CIN=Cervical Intraepithelial Neoplasia (6). LAST=Lower Anogenital Squamous Terminology Standardization (13). LSIL=Low Grade Squamous Intraepithelial Lesion; HSIL=High Grade Squamous Intraepithelial Lesion. NILM=Negative for Intraepithelial Lesion or Malignancy; ASCUS=Atypical Squamous Cells of Undetermined Significance (15).
Figure 3
Figure 3
Attribution of carcinogenic HPV types to cervical disease categories Expanded from (11). The type attribution is based on the hierarchical attribution model for carcinogenic genotypes present in multiple infections.
Figure 4
Figure 4
Prevalence of HPV infections, HSIL, and cancer by age The figure shows the natural history model and the corresponding prevalence of HPV infection, HSIL, and cancer in the population. Data on HPV infections are based on a summary of US-based HPV prevalence studies (50). The age distribution of HSIL is estimated based on data on CIN2 and CIN3 from Kaiser Permanente Northern California Health Maintenance Organization (P. E. Castle, personal communication) and the data on cancers are from the Surveillance, Epidemiology, and End Results 17 database (http://seer.cancer.gov/). Exemplary cervical cancer prevention strategies based on cytology, HPV testing, and HPV vaccination, are shown with the effective total number of screens among screen-negative women per lifetime (47).
Figure 5
Figure 5
Biomarkers for cervical disease categories
See this image and copyright information in PMC

References

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