Are Genital Infections and Inflammation Cofactors in the Pathogenesis of Invasive Cervical Cancer?
AbstractEDITORIALS Stephen E. Hawes, Nancy B. Kiviat ported that cervical inflammation, but not the diagnosis of a specific sexually transmitted disease, was associated with squamous intraepithelial lesions within the cervix. It is possible that the importance of various infections in the etiology of invasive cervical cancer might vary depending on the prevalence of these infectious agents in the population. Although Smith et al. (1) report that there was no statistically significant heterogeneity in the findings across the seven study sites, the ORs for the association between the risk of invasive cervical cancer and HSV-2 seropositivity among HPV DNA-positive women varied from 1.1 (for women in Colombia) to nearly 10 (for women in the Philippines). Similarly, rates of HSV-2 seropositivity in the control subjects across the seven study sites varied from less than 10% (for those in the Philippines and Spain) to nearly 57% (for those in Colombia). The risk of developing invasive cervical cancer that might be attributed to HSV-2 infection may vary according to differences in the prevalence of other unmeasured cofactors. The specific role of HSV-2 or other infectious agents in the pathogenesis of cervical cancer is unclear. Results of several in vitro studies in transfected