The Mashberg article, which now a decade old is still quoted the most at cancer conferences in relationship to the % of OC patients in which tobacco was a contributing factor, uses 75% as the number. Clearly in the US, the etiology of this disease is in transition. Tobacco use in the US has declined every year for the last 12 years. If that is the primary etiology of OC, then how can the occurrence rate of OC stay at the same level, and even increase slightly this year? (Almost 1,000 additional cases. ACS projections based on SEER nubers.) The fact is that because the fastest growing segment of the OC population is no longer the typical over 50, 2 to 1 black over white, 3 to 1 male over female, tobacco user - and is now someone between 20 and 50 who is a non smoker, predominantly white, educated, and with females slightly edging out males, they believe that HPV is the replacement causative agent keeping the numbers high and where this new sub demographic is coming from. Smokers and tobacco chewers however are still at the top of the pile in total numbers. But as America loses its love affair with tobacco, viruses are taking its place in the OC world.