Comment by ejstronge
2 days ago
> You can develop cervical cancer via some other route, but the vast, vast majority of cervical cancers are caused by HPV infection.
What are these other ways? There's an intuition that bodies are like computer programs that can fail in unpredictable ways, but this is usually false and belies a failure to see links between 'novel' and previously described mechanisms.
Computer programs always fail in predictable — but usually unpredicted — ways.
Human bodies, not so much, mostly because we lack the capability to monitor, measure and emulate the behaviour of such complex systems. As such, we gain medical knowledge using statistics, usually covering most common "failure modes" first, but we increasingly learn that those are never as clear cut either as our observation technology improves (as it does with science otherwise too — eg. Newtonian mechanics is completely true up to some error bars and constraints achievable in that period).
Spontaneous mutations? Which no matter how much you carve out modifiable risk factors will always be a thing. At least 5% of cervical cancers are HPV negative, so it's not even all the uncommon (not I would call "vast, vast" IMHO)
> Spontaneous mutations? Which no matter how much you carve out modifiable risk factors will always be a thing. At least 5% of cervical cancers are HPV negative
Random mutations causing cervical cancer essentially does not happen - as a sibling commenter writes, well-studied cases of this are so rare that they’re below our sensitivity of detection/technical error rates.
This is what I mean when I say we try to apply our intuitions to medicine - they’re not reliable and the truth is idiosyncratic.
Because our prior for cervical cancer being caused by HPV is so incredibly high, we would require overwhelming evidence to reject the hypothesis that any new case is due to HPV. There are ways to do this, and, should they be attained, would be published in a reputable journal based on their novelty.
> as a sibling commenter writes, well-studied cases of this are so rare that
And yet not a single cite in sight. A random commenter on orange site is not evidence
However I know the paper they are referring to - it is from 1999 in J Pathology, famous at the time, and it is woefully out of date.
> they’re below our sensitivity of detection/technical error rates.
Hogwash.
https://www.mdpi.com/2076-0817/14/7/668
> There are ways to do this, and, should they be attained, would be published in a reputable journal based on their novelty.
There are plenty of papers on HPV independent cervical cancer based on actual gene expression methods published in reputable journals in the last 30 years.
Where did you see 5%? I'm not an expert (though I think I know one) but the study I'm looking at says 0.3% - hence my "vast, vast". That's 3 patients out of 1000.
In that study they take cancer cells and check for HPV, get about 7% negatives which I'm guessing is what you're describing too, but they take those negatives and PCR them to figure out, well, OK, what was wrong with these cells and when you take the cells to pieces very often your assay goes oh, these instructions are HPV. So, you know, the cancer cells aren't "infected" with HPV but well the genetics are just HPV, the replication has gone haywire and tangled parts of HPV with the human cell instructions and now it's cancer.
Crucially we can assume that if you don't get infected with HPV this wouldn't happen. So HPV was still causal.
> Crucially we can assume that if you don't get infected with HPV this wouldn't happen. So HPV was still causal.
Nope. This is literally “correlation does not equal causation” 101. Based on the 0.3% I’m gonna guess you’re (either directly or indirectly) citing a famous, 1999 paper in J Pathology (Walboomers et al). It’s outdated, missing a control *, and it’s pretty well accepted that just finding a bystander HPV DNA fragment around somewhere is not conclusive of causality. We have much more sophisticated assays of gene expression. Try looking for review articles in the last 3 to 4 years rather than 30, the prevalence of truly HPV independent cervical cancer is not precisely characterized but it’s almost certain much greater than 0.3%.
https://www.mdpi.com/2076-0817/14/7/668
https://journals.lww.com/md-journal/fulltext/2024/10110/rese.... (3% to 8%)
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