Cigarette Smoking and Human Papillomavirus in Patients With Reported Cervical Cytological Abnormality

Abstract

Objective-To assess the relation between two risk factors for cervical neoplasia: smoking and infection with oncogenic human papillomavirus. It has been suggested that smoking causes a local immunological defect, which could facilitate the infection and persistence ofhuman papillomavirus. Design-Cross sectional epidemiological study. Completion of a structured questionnaire by the patients, analysis of cervical scrapes for human papillomavirus, and morphological examination of biopsy specimens. Setting-Outpatient gynaecological clinic. Subjects-181 women with a report of cervical cytological abnormality. Main outcome measures-Prevalence of infection with oncogenic human papillomavirus and smoking habits. Results-Oncogenic human papillomavirus was found in the cervix of 26 (41%) of the 63 women who did not smoke, 22 (58%) of the 38 who smoked 1-10 cigarettes a day, 28 (61%) of the 46 who smoked 11-20 cigarettes a day, and 26 (76%) of the 34 who smoked ¢ 21 cigarettes a day. The prevalence of the virus thus increased in accordance with the number of cigarettes smoked (p=0001). This relation remained after adjustment for age at first intercourse and lifetime number of sexual partners. Of the 63 non-smokers, 23 had previously smoked at least 10 cigarettes a day at some time. Ofthese 23 women, 14 (61%) had oncogenic human papillomavirus in their cervix. Of the 40 women who had never smoked at least 10 cigarettes a day, 12 (30%) had the virus. The prevalence of oncogenic human papillomavirus in non-smokers therefore depended on previous smoking habits (p=0.03). Conclusion-The dose dependent effect of cigarette smoking on the occurrence of oncogenic human papillomavirus favours a causal relation between these risk factors for cervical neoplasia.

Human Papillomavirus, Smoking, and Cancer

“…The relative risk (RR) was 2.5 (CI = 1.8-3.4) for their 728 subjects (206 smokers). A dose-dependent response was also found by Kjaer et al 12 and Burger et al 13 in their 645 and 181 subjects, respectively. Ex-smokers were found to have a risk intermediate between that of current smokers and that of nonsmokers (RR smokers = 2.4 with 95% CI = 1.7-3.4; RR ex-smokers = 1.6 with 95% CI = 1.0-2.7).…”

“…10 Recent large series of cervical cancer cases have also been reported from Thailand, the Philippines, and Sweden. [13][14][15] In 377 cases of cervical cancer in Thailand, the adjusted RR for smokers was 2.3 (CI = 1.6-3.4) and for only HPVpositive smokers, the RR was 2.8 (CI = 1.0-7.6). 14 In 356 cases of cervical cancer in the Philippines, the adjusted RR for all those who had squamous cell carcinoma and had ever smoked was 3.3 (CI = 2.1-5.2), and for only HPV-positive women smokers the RR was 6.6 (CI = 0.8-55.0).…”

Tubal Sterilization and Use of an IUD and Risk of Cervical Cancer

“…The ascertained risk factors have been observed also by others to be related to cervical cancer, including age at marriage, [45][46][47][48] poor genital hygiene, [49][50][51][52][53] and smoking, [54][55][56][57][58] which provides reassurance as to the validity of the data collected for this investigation.…”

The Interplay Between Secondhand Cigarette Smoke, Genetics, and Cervical Cancer: A Review of the Literature

“…In a study by Burger, Hollema, Gouw, Pieters, and Quint (1993) ''oncogenic HPV was found in the cervix of 26 (41%) of the 63 women who did not smoke, 22 (58%) of the 38 women who smoked 1-10 cigarettes a day, 28 (61%) of the 46 who smoked 11-20 cigarettes a day, and 26 (76%) of the 34 who smoked 21 cigarettes a day'' (p. 1269). This study revealed not only a correlation between cigarette smoking and cervical neoplasia, but also a dosedependent relationship between the two.…”