Cervical cancer: advances in prevention and knowledge of its etiology.

O n a global basis, cervical cancer still generates close to half a million new cases per year, of which half would die as a consequence. These figures are strongly related to socioeconomic level of development, with the burden of the disease heavily affecting developing populations. We now understand the causes of cervical cancer and novel prevention methods are being developed and introduced into medical practice. It is thus the hopeful beginning of a time that should result in the drastic reduction of cervical cancer worldwide. Mexico cumulates risk factors for cervical cancer. The prevalence of Human Papillomavirus (HPV) DNA in women above 35 years of age is as high as 15%, parity is high in most social groups and screening offers a limited coverage for a substantial proportion of the population. In spite of efforts, the organization of screening programs such as the ones conceived and implemented in North America and in some countries in Europe has been of limited value. For most populations it is not possible to demonstrate neither that cytology-based programs are improving nor that cervical cancer mortality is being reduced as a consequence. This scenario is and has been dismayingly similar to other countries in the region and current estimates of the number of invasive cervical cancer still indicate some 70 000 new cases per year occur in Central and South America, with a high mortality rate. When in the early 80’s the technology was developed to allow testing for the DNA of the HPV in exfoliated cervical cells, the field exploded. With these resources, epidemiological studies were able to confirm that most of the observed risk associations were in fact mediated by the persistent presence of HPV DNA. The finding is of utmost importance because the high-risk types of HPV seem to be necessary for the development of all cervical cancer cases worldwide. As a consequence, EDITORIAL