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Discovering the causes of cancer and the means of prevention

Infectious Agents

Over the years, DCEG research on the association between infectious agents and cancer has made a significant impact in the following areas:

Human Papillomavirus (HPV)

Starting in the 1980s, DCEG investigators carried out landmark studies on the natural history of cervical cancer that firmly established HPV as the necessary cause of this malignancy (Schiffman et al., 1993, 2007). Their efforts laid the groundwork for vaccine development and improved strategies for screening.

The licensure of prophylactic HPV vaccines in the mid-2000s raised the potential to reduce a large fraction of the disease burden of cervical cancer. However, the cost and logistical challenges of administering the current three-dose regimen create a barrier to vaccinate young-adult women in low-resource settings. DCEG investigators reported that one or two doses of an HPV 16/18 vaccine may prevent cervical cancer just as effectively as three doses (Kreimer et al., 2011). A one- or two-dose program could lower the cost of vaccination and encourage the global dissemination of the vaccine. DCEG investigators also reported that the HPV 16/18 vaccine provides strong protection against anal HPV infections that could eventually lead to anal cancer (Kreimer et al., 2011). More information on HPV and cervical cancer.

In 2012 the U.S. Preventive Services Task Force and a coalition of health organizations  published new guidelines for cervical cancer screening. DCEG research into the benefits of incorporating HPV testing into cervical cancer screening programs (Katki et al., 2011) have informed these revised guidelines. More information on HPV and cervical cancer.

Human Immunodeficiency Virus (HIV)

DCEG research provided the initial assessment of the specificity, sensitivity, and appropriate applications of the first-generation HIV antibody testing system for diagnosis of HIV infection (Weiss et al., 1985). As a result of this work, those tests became standard care in the routine clinical practice of diagnosing individuals thought to have contracted HIV.

A prospective study of HIV infection and the development of AIDS in subjects with hemophilia showed that a much larger proportion of HIV-infected persons would develop AIDS than previously thought (Goedert et al., 1989), a finding with broad impact for public health prevention programs and clinical practice.

DCEG research led to the recognition that CD4 count and HIV viral load predict risk for the development of full-blown AIDS and death from AIDS (Goedert et al., 1987, 1989; Ehmann et al., 1994; O’Brien et al., 1996). These biomarkers are now the standard measures used to inform routine clinical care of HIV-positive patients, including counseling, screening, and medication management.

New worker safety recommendations for the handling of concentrated HIV samples in the laboratory were influenced by a DCEG study of HIV infection among laboratory workers (Weiss et al., 1988).

DCEG biostatisticians applied novel statistical methods to derive estimates of HIV prevalence in the U.S. population. Their findings revealed that prevalence was greatest among heterosexual individuals (Rosenberg et al., 1991; Rosenberg, 1995; Rosenberg and Biggar, 1998).

Other Infectious Agents

U.S. poliovirus vaccines were accidentally contaminated with simian virus 40 (SV40). These contaminated doses were widely administered from l955 through 1962. The public was alarmed by the possible risks from exposure to this oncogenic virus. DCEG investigators published results from after a study of newborns who received SV40-contaminated polio vaccine showing no increased risk of cancer (Fraumeni et al., 1963; Fraumeni et al., 1970; Mortimer et al., 1981).

The Food and Drug Administration (FDA) recommended screening all blood donations for human T-cell leukemia virus type I and II (HTLV-I/II) antibodies, based on DCEG research that demonstrated increased risks of HTLV-1 and associated complications following exposure to HTLV-I/II in contaminated blood (Blattner et al., 1982; Blayney et al., 1983).

The FDA decided not to screen the U.S. blood supply for human herpesvirus 8 (HHV-8) after DCEG research demonstrated that serological tests for HHV-8 had poor reproducibility (Rabkin et al., 1998).

DCEG studies linking Helicobacter pylori infection to the very high incidence of gastric cancer and precancerous lesions in Shandong province in China prompted a clinical trial that showed a sustained reduction in risk following a two-week course of antibiotics (You et al., 2006; Zhang et al., 2006; Ma et al., 2012; Li et. al., 2014).

Infectious Agents: Full list of article citations

Learn about our current research on infectious agents