Available data demonstrate an increase in the transcription of high-risk papillomaviruses by the 16␣-hydroxylation of estrogens, which is in line with the epidemiologic data showing an increased cervical carcinogenesis risk for long-term contraceptive-using, HPV-infected women. No evidence exists for an increase in HPV-negative contraceptive users. © 2002 Wiley-Liss, Inc.
Key words: HPV; hormone; cervical intraepithelial neoplasia; cervical cancerInfection by papillomaviruses is essential for the development of cervical cancer (reviewed by zur Hausen 1 ). A number of the papillomavirus types (high-risk) have been associated with and demonstrated in premalignant and malignant lesions of the genital tract. The infection per se is, however, not sufficient to induce malignant conversion. A complex interplay between viral and cellular genes is required to disrupt the cell-cycle control and induce immortalization, followed by progression to malignant conversion. The molecular mechanism through which papillomaviruses, in particular HPV-16 and HPV-18, participate to achieve this condition has been well established. The low-risk mucosal papillomaviruses, causing benign lesions mainly of the genital tract, share several functional characteristics with the high-risk mucosal papillomaviruses but lack others necessary for the immortalization of normal keratinocytes (reviewed by zur Hausen 2 ). The maintenance of a high level of certain viral proteins within the cell is necessary for the virus to induce and regulate distinct cellular pathways. Several exogenous and endogenous factors controlling or influencing viral transcription and the expression of the viral oncogenes, E6 and E7 in particular, are known. Very few data are available on the in vitro and in vivo mechanisms through which steroid hormones, in particular, influence the carcinogenic process induced by high-risk papillomavirus infections.Steroid hormones exert a broad range of biologic functions. The synthesis, transport and metabolism of the naturally occurring hormones are tightly regulated in various organs of the body (reviewed by Clemens and Goss 3 and Gruber et al. 4 ). A delicate balance exists during the premenstrual, menstrual and postmenopausal phases of the female body, as well as during pregnancy. This balance is greatly influenced by the intake of exogenous steroid hormones in the form of OCs in young women or HRT in postmenopausal women. Reports in which epidemiologic data taken from 8 case-control studies have been pooled and analyzed indicate an increased risk for developing cervical carcinoma in women with high parity 5 or after the long-term use of OCs. 6 Odds ratios were 3.8 for cervical carcinoma after 7 full-term pregnancies, and 2.3 for women with 1 or 2 full-term pregnancies, respectively. Odds ratios for use of OCs were 2.82 for 5-to 9-year use and 4.03 for 10-year or longer use. Other epidemiologic studies have also reported an increased risk of developing cervical adenocarcinoma among long-term users of OCs. [7][8][9] Regulation of viral ...