A case–control study of endogenous hormones and cervical cancer

Abstract

Both parity and oral contraceptive use are associated with elevated circulating levels of sex hormones, at least transiently, and with increased risk of cervical cancer in human papillomavirus (HPV)-infected women. We directly evaluated whether elevations in the physiologic levels of these hormones predispose to the development of cervical neoplasia. We identified 67 premenopausal and 43 postmenopausal women with cervical intraepithelial neoplasia 2, 3, or cervical cancer (XCIN2) diagnosed during enrollment of a population-based cohort of 10 077 women. Four controls, two chosen randomly and two chosen from women testing positive for cancer-associated HPV, were matched to each case on menopausal status, age, days since last menses (pre), or years since menopause (post). Sex hormone-binding globulin, oestradiol, oestrone, oestrone-sulphate, dehydroepiandrosterone sulphate, and progesterone were measured in enrollment plasma. There was no consistent association between the sex hormones and risk of XCIN2. Excluding cases with invasive disease had a minimal impact on results. Though this case -control study was based on a welldefined population, it was limited by reliance on a single measure of hormone levels taken at the time of diagnosis. Nonetheless, our results do not support the hypothesis that plasma levels of sex hormones have an important bearing on the risk of cervical neoplasia in HPV-infected women.

Endogenous Sex Steroids and Risk of Cervical Carcinoma: Results from the EPIC Study

“…The partial disagreement between our findings and those of Shields and colleagues (14) may be explained by the fact that cases in their study mainly included CIN2 and CIN3 (85 of 110), whereas the association we found with T and fT and, possibly, E 2 levels were restricted to ICC. Lack of association for CIN2 and CIN3 may suggest that sex steroid hormones act during the late stages of cervical carcinogenesis.…”

“…The relationship between circulating sex steroid hormones and the risk of cancerous or precancerous cervical lesions has been previously investigated in 3 case-control studies (12,13,14). Zheng included 51 postmenopausal women with ICC and 52 cancer-free postmenopausal women (12).…”

“…Serum E 2 levels were significantly higher among ICC cases than in either control group whereas progesterone level did not differ. Shields and colleagues compared cross-sectionally plasma E 2 , estrone, SHBG, DHEAS, and progesterone levels in 110 women with CIN2, 3, or ICC to 440 women with normal cytology or CIN1 selected within the Guanacaste cohort study, Costa Rica (14). Half of the control women were chosen among HPV-positive women.…”

“…To date, the association between serum or plasma levels of sex steroid hormones and the risk of ICC or CIN2 or 3 has been only evaluated in 3 case-control studies yielding inconsistent results (12,13,14). The aim of the present study was to assess the relationship between prediagnostic levels of sex steroid hormones and the risk of ICC and CIN3 in women enrolled in a prospective study, the European Prospective Investigation into Cancer and Nutrition (EPIC).…”

Cervical Intraepithelial Neoplasia – Clinical and Etiological Aspects

“…None of the hormones measured did correlate to lesions more or equal to CIN2 compared to low-grade CIN. Serum levels of sex steroids thus have not proved to be useful in distinguishing low-and high-grade lesions 69 .…”