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Half of the Nobel Prize in Physiology and Medicine for 2008 has been awarded to Harald zur Hausen, a German virologist, for “his discovery of human papilloma viruses (HPV) causing cervical cancer”. Does this decision ignore or belittle the contribution of epidemiology to the discovery?
In an editorial in the Journal of the National Cancer Institute in 2001, zur Hausen carefully established the priority of his contribution over that of epidemiology.1 Between 1976 and 1985, he had postulated the role of HPV in cervical cancer, demonstrated specific HPV types in cancer biopsy specimens and cervical carcinoma cell lines and demonstrated their specific integration and gene expression patterns in tumours and cell lines but, zur Hausen noted, these contributions, “were met with remarkable skepticism by several epidemiologists”.1
International case–control studies in the 1980s had not found an association between HPV and cervical cancer, most likely because of misclassification from still inaccurate HPV DNA assays. For the International Agency for Research on Cancer (IARC), in 1989, the jury was still out with respect to the causal link between HPV and cervical cancer.2 Things changed in the 1990s. Under the leadership of Nubia Muñoz, an epidemiologist from IARC, new epidemiological results showed that subtypes of HPV were strongly associated with cervical cancer.3 4 According to zur Hausen, these results, “were taken as firm evidence for HPV causality in cervical cancer”.1 Indeed, in 1995, an international evidence-based consensus was reached that some, but not all, HPV types were causally related to cervical cancer.5 zur Hausen added that the epidemiological evidence was instrumental “to convince the pharmaceutical industry to consider the initiation of vaccination programs against high-risk HPV infections”.1
In this context, who actually discovered that HPV caused cervical cancer? zur Hausen pioneered the idea. In 1976, at …
Competing interests: None.