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Cambridge Immunology Network



Pathogenesis of Human Papillomavirus Infections

The papillomaviruses are a large group of pathogens which infect skin and mucous membranes where they induce a spectrum of proliferative disorders from warts to cancer. A subgroup of human papillomavirus (HPV) types, particularly HPV 16 and 18 and their relatives, is closely associated with the development of certain human cancers, most notably cervical cancer. This raises the possibility that intervention in the natural history of HPV infection in the genital tract by prevention or treatment could have a major impact on this cancer, the second commonest malignancy in women in the world.

The ways in which the cell may control the life cycle of the virus and conversely how the virus may exert effects on the growth and differentiation of the host cell are still tantalising mysteries. The contribution of the immune response to papillomavirus infection can greatly affect the degree and duration of disease. Understanding the ways in which the immune system develops a response to the human papillomavirus is important if effective vaccines against viral-associated disease are to be produced.

A phase of dysplastic growth of the genital epithelium can precede invasive cancer and is frequently associated with human papillomavirus infection. A search for the cellular and viral changes that could control the progression of neoplastic disease forms another area of research focus.

Margaret is also an Honorary Fellow of the Royal College of Obstetricians and Gynaecologists and has a lifetime award from the International Papillomavirus Society.


Public and Patient Involvement/Engagement

Professor Stanley is involved in public engagement as an advisor to Jo’s Trust, a cervical cancer charity, and the Throat Cancer Foundation, a charity focussed on oral and throat cancers caused by HPV; she answers questions from patients and their families about the disease and what infection with the virus means for prevention and treatment.

Professor Stanley currently has two HPV vaccine trials in Africa the HANDS trial in the Gambia (immunogenicity of 1 or 2 doses of vaccine in adolescents 9-13 compared to children 4-6) and the Add Vac trial (will immunising boys as well as girls impact on virus prevalence when immunisation of girls falls below 50% coverage) in Tanzania.  She is also on the Trial Steering committee for the DORIS trial in Tanzania and two trials in Costa Rica both looking at one versus two doses of HPV vaccine with immunogenicity endpoints (Doris) and efficacy endpoints (Costa Rica). 


Key publications: 

Lazcano-Ponce E, Stanley M, Munoz N, Torres L, Cruz-Valdez A, Salmeron J, et al. Overcoming barriers to HPV vaccination: non-inferiority of antibody response to human papillomavirus 16/18 vaccine in adolescents vaccinated with a two-dose vs. a three-dose schedule at 21 months. Vaccine. 2014;32(6):725-32.

Stanley M. HPV vaccination in boys and men. Human vaccines & immunotherapeutics. 2014;10(7):2109-11.

Stanley M, O'Mahony C, Barton S. HPV vaccination. Bmj. 2014;349:g4783.

Stanley MA, Sterling JC. Host responses to infection with human papillomavirus. Current problems in dermatology. 2014;45:58-74.

Lowy DR, Herrero R, Hildesheim A; Participants in the IARC/NCI workshop on Primary Endpoints for Prophylactic HPV Vaccine Trials.Primary endpoints for future prophylactic human papillomavirus vaccine trials: towards infection and immunobridging. Lancet Oncol. 2015 May;16(5):e226-33. doi: 10.1016/S1470-2045(15)70075-6.

Stanley MA, Sudenga SL, Giuliano AR. Alternative dosage schedules with HPV virus-like particle vaccines. Expert Rev Vaccines. 2014;13(8):1027-38.

Garland SM, Subasinghe AK, Jayasinghe YL, Wark JD, Moscicki AB, Singer A, et al. HPV vaccination for victims of childhood sexual abuse. Lancet. 2015;386(10007):1919-20

Hernandez-Avila M, Torres-Ibarra L, Stanley M, Salmeron J, Cruz-Valdez A, Munoz N, et al. Evaluation of the immunogenicity of the quadrivalent HPV vaccine using 2 versus 3 doses at month 21: An epidemiological surveillance mechanism for alternate vaccination schemes. Human vaccines & immunotherapeutics. 2016;12(1):30-8.

Radley D, Saah A, Stanley M. Persistent infection with human papillomavirus 16 or 18 is strongly linked with high-grade cervical disease. Human vaccines & immunotherapeutics. 2016;12(3):768-72.

Stanley M. Preventing cervical cancer and genital warts - How much protection is enough for HPV vaccines? The Journal of infection. 2016;72 Suppl:S23-8.

Van Damme P, Bonanni P, Bosch FX, Joura E, Kjaer SK, Meijer CJ, et al. Use of the nonavalent HPV vaccine in individuals previously fully or partially vaccinated with bivalent or quadrivalent HPV vaccines. Vaccine. 2016;34(6):757-61.

Arrossi S, Temin S, Garland S, Eckert LO, Bhatla N, Castellsague X, et al. Primary Prevention of Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Guideline. Journal of global oncology. 2017;3(5):611-34.

Garland SM, Brotherton JML, Moscicki AB, Kaufmann AM, Stanley M, Bhatla N, et al. HPV vaccination of immunocompromised hosts. Papillomavirus research. 2017;4:35-8.

Hendry M, Pasterfield D, Gollins S, Adams R, Evans M, Fiander A, et al. Talking about human papillomavirus and cancer: development of consultation guides through lay and professional stakeholder coproduction using qualitative, quantitative and secondary data. BMJ open. 2017;7(6):e015413.

Stanley M. Tumour virus vaccines: hepatitis B virus and human papillomavirus. Philos Trans R Soc Lond B Biol Sci. 2017;372(1732).

Stanley M, Poljak M. Prospects for the new HPV Prevention and Control Board. Papillomavirus research. 2017;3:97.

Solomon D, Stanley M, Robinson AJ. Anal cancer in women: are we appropriately identifying the risks? Sex Transm Infect. 2017 Nov;93(7):455-456. doi: 10.1136/sextrans-2017-053165.

SM Garland, A. Giuliano, JML Brotherton, AB Moscicki, M. Stanley, AM Kaufmann, N. Bhatla, R. Sankaranarayanan, JM Palefsky, S. de Sanjose, on behalf of IPVS IPVS statement moving towards elimination of cervical cancer as a public health problemPapillomavirus Res. 2018 Jun; 5: 87–88. Published online 2018 Feb 27. doi: 10.1016/j.pvr.2018.02.003 PMCID: PMC5887016

Williamson AL, Garland S, Palefsky J, Rybicki E, Stanley M, de Sanjosé S.The Cape Town declaration on human papillomavirus related disease. Papillomavirus Res. 2017 Dec 30;5:59-60. doi: 10.1016/j.pvr.2017.12.003. [Epub ahead of print]. PMID 2929435

Petry KU, Bollaerts K, Bonanni P, Stanley M, Drury R, Joura E, Kjaer SK, Meijer CJLM, Riethmuller D, Soubeyrand B, Van Damme P, Bosch X Estimation of the individual residual risk of cervical cancer after vaccination with the nonavalent HPV vaccine.Hum Vaccin Immunother. 2018 Mar 19:1-23. doi: 10.1080/21645515.2018.1450125. [Epub ahead of print] PMID:29553886

Donovan B, Callander D, Stanley M.Reply to San Giorgi and Dikkers. JID April 2018

J Infect Dis. 2018 Apr 11;217(9):1506. doi: 10.1093/infdis/jiy019 PMID: 2945237

Lazcano-Ponce E, Torres-Ibarra L, Cruz-Valdez A, Salmerón J, Barrientos-Gutiérrez T, Prado-Galbarro J, Stanley M, Muñoz N, Herrero R, Hernández-Ávila M. Persistence of immunity when using different HPV vaccination schedules and booster dose effects at 5 years post-primary vaccination. J Infect Dis. 2019 Jan 1; 219(1): 41–49.. doi: 10.1093/infdis/jiy465.

Schiffman M, Doorbar J, Wentzensen N, de Sanjosé S, Fakhry C, Monk BJ, Stanley MA, Franceschi S.

Carcinogenic human papillomavirus infection. Nat Rev Dis Primers. 2016 Dec 1;2:16086.




Professor Margaret  Stanley
Available for consultancy