Xian Wen Jin, MD: 
Dr. Monk, thank you so much for an excellent presentation on the natural history and pathogenesis of cervical cancer.  Can you tell me a little bit about the prevalence of HPV?  Let’s say in the audience who is listening today to this program, in your opinion, what would be the percentage of folks that may have HPV? 

Bradley J. Monk, MD: 
We say, and maybe this is an exaggeration, that 80% of individuals who are sexually active get HPV at some time in their life, which does not really address your question, which was prevalence of HPV today.  So, HPV today is perhaps maybe 10% or so, and it depends on the population, but I think it’s important to state that 10% is still a lot.  Even though you may not have it today, you may get it in the future, or you may have gotten it in the past or gotten over it. But this virus is everywhere, and I think I already said it, this is a virus that is easy to get.  HIV is very tough.  If you have a sexual encounter with a person that has this virus, you have over a 50% chance of getting it. 

Xian Wen Jin, MD: 
Based on your presentation, now we understand that HPV is a cause for cervical cancer.  Now, is there any cancer of the cervix that is not caused by HPV infection?

Bradley J. Monk, MD: 
I think I also need to qualify your last question.  Most people that get the virus don’t get cancer.  In fact, less than 1 in 100, maybe even less than 1 in 1000, so that is really important as we move forward and start to talk about this.  I do not want you as a caregiver, or as a patient, think if you are diagnosed with the virus, “Oh, I am going to get cancer.”  It is really a method of risk stratification.  

But, to your question, I told you that 99.7% of cervical cancers have HPV.  And in fact, in my mind, if there is not HPV in it, it’s not cervical cancer.  You may say, well the cancer is in the cervix.  Well, yeah; it is a breast cancer that spread to the cervix; or it’s a cervical sarcoma, which is technically a cervical cancer, but in my mind not a squamous or an adenocarcinoma.  In fact, that is really not a carcinoma, it is a sarcoma, or probably the most common cancer in the cervix that is not HPV related is an endometrial cancer that grows down into the cervix.  

So, I am very comfortable saying that all cervical cancer, carcinoma, is caused by HPV, but there really are some rare exceptions, as I mentioned.  Metastatic disease, sarcomas, and endometrial cancers growing down.

Xian Wen Jin, MD: 
Thank you.