Cervical infections by approximately 15 cancer-associated (carcinogenic or high-risk) human papillomavirus (HPV) genotypes cause virtually all cervical cancer and its immediate
precursors worldwide.3 A new paradigm of cervical carcinogenesis replaces an older pathology model of stepwise progression from low-grade to high-grade morphologic changes and can now be summarized as 4 reliable measured stages: 1) HPV acquisition, 2) HPV persistence (vs clearance), 3) progression of a persisting infection to cervical precancer, and 4) invasion.6
Globally, HPV is the most common sexually transmitted infection. The majority of HPV infections, including carcinogenic HPV genotypes, are typically transient and resolve within 6 to 12 months, occasionally causing mild morphologic changes. In general, it can be said that carcinogenic HPV is the necessary but infrequent cause of cervical cancer. That cervical cancer is the second most common cancer worldwide is to a great extent a result of the nearly ubiquitous exposure to HPV after sexual debut. Women with persistent carcinogenic HPV infections are at risk of developing precancer,6 although not all persistent infections progress to precancer. If precancer is not detected and treated in a timely manner, a significant proportion can invade.