Correspondence

Classification of Human Papillomavirus

N Engl J Med 2003; 348:2040-2041May 15, 2003

Article

To the Editor:

Muñoz et al. (Feb. 6 issue)1 classified human papillomavirus (HPV) types 81 and 73 as low-risk and high-risk HPV types, respectively, on the basis of their relative frequency in cervical cancer. This is in agreement with our previous report of the prevalence of these HPV types in normal, benign, and malignant cervical lesions.2 However, we do not agree with the classification of HPV type 53 as a probable high-risk type.

Although Muñoz et al. did not detect HPV type 53 in 259 HPV-positive controls, they identified it in only 1 of 1739 HPV-positive patients. This low prevalence was also found in a meta-analysis.3 By analyzing cervical smears of different pathological features, we detected a higher prevalence of HPV type 53 in normal smears and in low-grade squamous intraepithelial lesions than in high-grade squamous intraepithelial lesions.2 In our opinion, current epidemiologic data do not justify the classification of HPV type 53 as a probable high-risk HPV type.

Thomas Meyer, Ph.D.
Institute of Immunology, Clinical Pathology, and Molecular Medicine, 22339 Hamburg, Germany
meyer@labor-arndt-partner.de

Eggert Stockfleth, M.D.
Charité, Humboldt University, 10117 Berlin, Germany

3 References

1. 1

   Munoz N, Bosch FX, de Sanjose S, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003;348:518-527
   Full Text | Web of Science | Medline

2. 2

   Meyer T, Arndt R, Beckmann ER, Padberg B, Christophers E, Stockfleth E. Distribution of HPV 53, HPV 73 and CP8304 in genital epithelial lesions with different grades of dysplasia. Int J Gynecol Cancer 2001;11:198-204
   CrossRef | Web of Science | Medline

3. 3

   Clifford GM, Smith JS, Plummer M, Munoz N, Franceschi S. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer 2003;88:63-73
   CrossRef | Web of Science | Medline

Author/Editor Response

Our epidemiologic classification was based not only on HPV-type–specific prevalence in patients with cervical cancer, but also on prevalence in control women, on HPV-type–specific odds ratios, or on both these characteristics. According to these criteria, HPV type 53 was considered a probable high-risk type because it was identified in 1 of 1739 HPV-positive patients as a single infection (and in 2 patients with multiple infections) but was not detected in any of 1928 control women. Similar figures were reported in a recent meta-analysis.1 Moreover, it has been classified phylogenetically as a high-risk type.

We share the reservations of Meyer and Stockfleth regarding the categorization of HPV type 53 as a high-risk type because of its very low prevalence in patients with cervical cancer in our study and its relatively high prevalence, reported elsewhere, in women with normal cytologic findings, condylomas, or low- or high-grade intraepithelial lesions.2 We described HPV type 53 as a “probable” high-risk type to indicate that further research is needed to assess the risk associated with this type.

Nubia Muñoz, M.D.
International Agency for Research on Cancer, F-69372 Lyons CEDEX 08, France
cris@ico.scs.es

F. Xavier Bosch, M.D.
Catalan Institute of Oncology, L'Hospitalet de Llobregat, E-08907 Barcelona, Spain

Peter J.F. Snijders, Ph.D.
Vrije Universiteit Medical Center, 1081 HV Amsterdam, the Netherlands

2 References

1. 1

   Clifford GM, Smith JS, Plummer M, Munoz N, Franceschi S. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer 2003;88:63-73
   CrossRef | Web of Science | Medline

2. 2

   Nindl I, Arndt R, Schneede P, Christophers E, Stockfleth E, Meyer T. Low oncogenic potential of HPV 53 examined in patients with normal cytology, condylomata acuminata, CIN and cervical cancer. In: Villa LL, Barbosa ACC, Boccardo E, et al. eds. Program and oral presentations of the 19th International Papillomavirus Conference. Sao Paulo, Brazil: EDF Design Gráfico e Editoraçao, 2001:207. abstract.