Human Papillomavirus Vaccination and Screening in the Elimination of HPV-Associated Cancers: Evidence-Based Randomized Trials

Etiological Studies on Cervical Neoplasia – A Showcase of Causal Inferencing

Author(s): Matti Lehtinen *

Pp: 1-17 (17)

DOI: 10.2174/9789815305487124010003

* (Excluding Mailing and Handling)

Abstract

Preventive medicine is largely about identification of causes of diseases and their removal. Cervical cancer in Finland is firstly a showcase and secondly a use-case of preventive medicine. Firstly, etiological studies on cervical cancer were for long confounded by the fact that sexually transmitted infections are surrogates of both risktaking behaviour in adolescent and young adult population, and occurrence of cervical cancer in middle-aged women. Identifying oncogenic human papillomaviruses (HPVs) as the true cause of cervical cancer among the multitude of different sexually transmitted micro-organisms required a Nobel-prize winning vision which was initially supported only by case-series evidence. It also required a paradigm shift that was facilitated by a correctly done epidemiological study and increased understanding on the molecular basis of exposure misclassification. All this was understood only after the etiological enigma had been resolved. Secondly, since the sexual revolution in 1960’s first facilitated increase in risk-taking sexual behaviour associated sexually transmitted infections’ incidence, and subsequently resulted in an increase in the incidence of cervical cancer. In the below Finnish use-case, the role of different causal (HPV16/18/31/45), intervening (Chlamydia trachomatis, smoking, HLA, HPV6/11) and non-causal (herpes simplex virus type 2) factors are put into perspective based on longitudinal, population-based studies. The established evidence base is now available for the evaluation of artificial intelligence/ machine learning performance in disclosing and judging causes of a chronic disease, cervical cancer. 


Keywords: Artificial intelligence, Causality, Cervical cancer, Chlamydia, Evidence hierarchy, Herpes simple virus, HLA, Human papillomavirus, Nested case-control study, Smoking.

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