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Discovering the causes of cancer and the means of prevention

Human Papillomavirus (HPV) and Cervical Cancer

More than 30 years of epidemiologic research by DCEG investigators has helped to establish the central causal role of carcinogenic genotypes of human papillomavirus (HPV) in the development of virtually all cases of cervical cancer. NCI’s natural history studies have shown that it is persistent HPV infection, and not the infection itself, that increases the risk of developing cervical cancer. This finding led to the creation and adoption of screening and clinical management guidelines by numerous organizations: the American Cancer Society, ASCCP, the Association of Clinical Obstetricians and Gynecologists, and the World Health Organization.  

NCI scientists also developed and validated HPV DNA testing that directly assays the causal virus. Now in widespread use in the U.S., the test provides greater accuracy than ambiguous Pap tests and has led to improved clinical management strategies, with lengthened screening intervals.

In addition, NCI scientists invented the virus-like particle technology that enabled the development of HPV vaccines to prevent infection and resultant cancer. An NCI-sponsored Phase III clinical trial to evaluate the efficacy of a vaccine against HPV types 16 and 18 showed near-complete protection against new infections and precancerous lesions. As a result, the U.S. strategy for the prevention of cervical cancer has been transformed from reliance on untargeted, frequent, and lifelong repetition of Pap smears to a combination of vaccination and targeted HPV-based screening.