Beyond human papillomavirus: The cervix, exogenous secondary factors, and the development of cervical precancer and cancer

Research output: Contribution to journalReview article

32 Scopus citations


Human papillomavirus (HPV) is the necessary but probably not sufficient cause of cervical precancer and cancer. Secondary exogenous and endogenous factors, HPV cofactors, may contribute to the probability of a cancer-associated (oncogenic) HPV infection progressing to cervical precancer and cancer. For these cofactors to influence the natural history of HPV infection, they must act on cervical tissue to promote viral persistence, progression to precancer or cancer given viral persistence, or both. The aim of this review was to examine briefly the impact these factors may have on carcinogenesis of the cervix. Specifically, the roles of the cervical transformation zone, cervical immunity, inflammation and coinfection, and exposure to the main HPV cofactors (smoking, oral contraceptive use, and multiparity) are discussed.

Original languageEnglish (US)
Pages (from-to)224-230
Number of pages7
JournalJournal of Lower Genital Tract Disease
Issue number3
StatePublished - Jul 1 2004
Externally publishedYes



  • Cervical cancer
  • Cofactors
  • Human papillomavirus
  • Transformation zone

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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