Key words: human papillomavirus infection; cervical cancer, epidemiology; ChinaThere is strong epidemiologic evidence indicating that human papillomavirus (HPV) plays a central role in the etiology of cervical cancer. [1][2][3][4] The women positive for HPV DNA have a risk of developing cervical cancer 15-50 times higher than those without HPV DNA. 1,2,4,5 Although HPV infection is common among young women, only a small minority go on to develop cervical cancer. This situation was reviewed by a group of researchers, who concluded that viral persistence of oncogenic HPV appears to be crucial for the development of cervical cancer. 6 Indeed, HPV-16, -18, -31 and -33 have been officially declared to be oncogenic by the World Health Organization (WHO). 7 The International Biological Study on Cervical Cancer (IBSCC) study group revealed that on average 92.9% of the tumors contained HPV DNA, with a range of 75-100%. 8 Although this international survey included 10 of the 18 regions of the world and provided the most extensive global view of HPV in cervical cancer, there were no data from China, 1 of the largest populations in the world. Furthermore, there are few published data from a well-designed study using a quality-controlled method on the prevalence of either HPV infection or HPV genotypes in cervical cancers in China.We conducted a multicenter study of HPV infection in cervical cancer by selecting 5 geographic regions of China: Shanghai (Eastern China), Guangzhou (Southern China), Sichuan (Western China), Beijing (Northern China) and Hong Kong (Specific Administration Region).
MATERIAL AND METHODS
PatientsCervical cancer specimens were collected from each of the 5 regions in China, including Shanghai, Guangzhou, Sichuan, Beijing and Hong Kong. Each of the 5 settings (Tumor Hospital, Shanghai Medical University in Shanghai, Tumor Hospital, Sun Yat-sen University of Medical Sciences in Guangzhou, Second Hospital, West China Medical University in Sichuan, Tumor Hospital, Chinese Academy of Medical Sciences in Beijing, and Prince of Wales Hospital, The Chinese University of Hong Kong in Hong Kong) was responsible for collecting 150 or more tumor specimens consecutively from the year 1997 to 1999. Patients from Hong Kong were prospectively recruited with informed consent, and all specimens were freshly frozen. Those specimens collected in other parts of China were paraffin-embedded and retrieved retrospectively from the pathology files in those reference centers. Ethical approvals were obtained from each of the ethical review boards of the respective institutes.
Histology reviewAll histologic slides submitted were reviewed by 1 of the investigators (M.K.M.C.) to reestablish the histologic type and