Case‐control study of risk factors for cervical neoplasia in Denmark. I: Role of the “male factor” in women with one lifetime sexual partner

Abstract

Possible risk factors for cervical cancer were investigated in 645 women, 20-49 years of age from Copenhagen, with histologically confirmed cervical cancer or carcinoma in situ and in 614 controls drawn at random from the female population of the same area. To study the role of the "male factor", monogamous cases and controls together with their husbands were invited for further examination. This included a personal interview, a blood sample for analysis of herpes simplex virus antibodies, and a penile swab for papillomavirus analysis. In total, 41 case couples and 90 control couples were enrolled (89% and 92% of eligibles, respectively). The most significant risk determinants were a history of genital warts in the male (RR = 17.9 for ever vs. never) and ever having used condoms (RR = 0.2). Other potentially important factors, although not statistically significant, were ever having visited prostitutes (RR = 2.6, p = 0.14). circumcision (RR = 0.3, p = 0.18). and a history of genital warts in the female (RR = 4.6, p = 0.09). Having a husband with a history of multiple sexual partners was also associated with an increased crude risk, but when adjustment was made for husband ever having had genital warts, use of condom, and age, no significant excess risk was observed. Human papillomavirus DNA, which was tested for with ViraPap and ViraType, was detected in one of the controls, and in only 2 case husbands. This study points to the importance of "high-risk males" for the development of cervical cancer in their sexual partner; the results support the infectious nature of the disease.It has been shown in numerous epidemiological studies that a woman's sexual behavior, especially her number of male partners and age at first intercourse, is closely related to her risk of cervical cancer and its precursor lesions. On this background, it has been hypothesized that cervical cancer is a sexually transmitted disease (Brinton and Fraumeni, 1986).However, the fact that some female populations exhibit high incidence rates of cervical cancer in spite of a tradition of having few sexual contacts, has focused interest on the male partners as important contributors to female risk of cancer of the uterine cervix (Skegg et al., 1982). Male partners of cervical cancer patients have a higher number of female partners than male partners of women without the disease (Buckley et al., 1981; Zunzunegui et al., 1986; Brinton et a l . , 1989) and these findings strengthen the indications that an important sexually transmitted agent is etiologically involved in cervical cancer. There is increasing experimental and molecular biological evidence that certain types of human papillomavirus (HPV) play a crucial role in the pathogenesis of cervical cancer (zur Hausen, 1989). Epidemiological evidence remains controversial.The purpose of the present study was to examine the role of the "male factor" in monogamous women and to evaluate, further, whether HPV infection and/or infection with herpes simplex virus type 2 (HSV 2) in the male partner are respo...

Epidemiology of human papillomavirus infection among fishermen along Lake Victoria Shore in the Kisumu District, Kenya

“…Some other studies among men have identified other independent factors associated with HPV infection that we did not either measure or find to be significant in this study, including circumcision status,6 28 condom use,9 type of sexual partner (casual partners and commercial sex workers),16 frequency of sexual activity, genital washing after sexual activity and perceptions about partners’ STI status. The cross-sectional nature of this study, relatively small sample size, inadequate assessment of sexual behaviours and condom use could partly explain the observed lack of association between HPV infection and the above listed independent factors.…”

Human Papillomavirus Infection Among 2460 Men in Denmark

“…9,16,17,20,21 In a population-based study of women in Denmark before the introduction of the HPV vaccine, HPV-16 and HPV-51 were among the commonest types. 28 In our study, men in their 20s had the highest prevalence of the commonest HPV types and most of the men positive for vaccine HPV types were aged 20 to 24 years. HPV-16, with HPV-18, accounts for most HPV-related cancers in men and is the commonest type detected in cervical cancer.…”

Prevalence and Determinants of High-Risk Human Papillomavirus Infection in Male Genital Warts

“…This result infers that the man with penile genital warts is a carrier of high-risk HPV to his sexual partner. In a case-control study in Denmark that investigated the role of the male factor, a history of genital warts in the male was shown to be one of the most significant risk determinants of cervical neoplasia [24]. A recent Danish cohort study showed that individuals with a diagnosis of genital warts had a long-term increased risk of anogenital cancers and head and neck cancers [22].…”