Summary A hospital-based case-control study was undertaken to examine the role of human papillomavirus (HPV) (e.g. HPV 6, 11, 42, 43, 44) have been associated with condylomata acuminata and CIN I (Howley, 1991;Lorincz et al., 1992).Epidemiological studies investigating the relation between HPV and cervical neoplasia have found strong associations . However, some of these studies are difficult to interpret because of methodological flaws in study design (Munoz et al., 1988) or because of the inaccuracy of the hybridisation techniques used to detect HPV DNA (Schiffman, 1992). Recently a reliable and sensitive HPV detection strategy based on the polymerase chain reaction (PCR) has been developed in several laboratories (Manos et al., 1989;van den Brule et al., 1990) and is now considered the technique of choice for epidemiological studies (Schiffman, 1992). Employing this technique, two recent studies have found high risks of cervical cancer associated with HPV (Peng et al., 1991;Munoz et al., 1992).In developing countries cancer of the cervix is the leading cancer even when sites common to both sexes are combined (Parkin et al., 1988). This hospital-based case-control study using PCR was undertaken to examine the role of HPV in the development of invasive cervical cancer in Sao Paulo, Brazil, a city with one of the highest incidence rates of this disease worldwide (Muir et al., 1987).
Patients and methods
Study populationBetween June 1990 and June 1991 women with a diagnosis of invasive cervical cancer and women selected as controls were recruited from seven hospitals in Sao Paulo City. Five of these are general hospitals, and two are hospitals for the treatment of cancer. The cases were women between 25 and 79 years of age, whose diagnosis was confirmed by histopathology and who had had no previous treatment for the disease. Controls were enrolled from the same five general hospitals from which the cases were recruited. For cases from the hospitals in which only cancer patients are treated (n = 48), controls were selected from the largest general hospital included in the study. This was because had the cancer cases had another disease it is likely that they would have been treated there as it is the most commonly used referral hospital in the city. Controls were frequency matched to cases in 5-year age groups. Those with diseases associated with known risk factors for cervical neoplasia were excluded (sexually transmitted diseases, coronary heart disease, cerebrovascular disease, arterial thromboembolism, thrombophlebitis, chronic bronchitis, emphysema, neoplasia of the breast, reproductive and respiratory organs, anus, oral cavity, oesophagus, bladder and liver). Women who were admitted for treatment of a gynaecological condition or who had had a hysterectomy or conisation were ineligible as controls. Women with a psychiatric illness were ineligible as cases or as controls. Evidence of a gynaecological or cytological abnormality detected on examination after recruitment was not a criterion for exclusion.A ...