Human papillomavirus and risk factors for cervical cancer in Chennai, India: A case‐control study

Abstract

To evaluate the role of human papillomavirus (HPV) and other risk factors in the aetiology of invasive cervical carcinoma (ICC), we conducted a hospital-based case-control study in Chennai, Southern India. A total of 205 ICC cases (including 12 adenocarcinomas) and 213 frequency agematched control women were included. HPV DNA in cervical cells was evaluated by means of a polymerase chainreaction assay. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were computed by means of unconditional multiple logistic regression models. HPV infection was detected in all but one ICC cases and in 27.7% of control women (OR ‫؍‬ 498). Twenty-three different HPV types were found. HPV 16 was the most common type in either cases or controls, followed by HPV 18 and 33. Approximately 125,000 new cervical cancer cases have been estimated to have occurred in India in 2000 (i.e., nearly one-third of all new cervical cancer cases worldwide). 1 Incidence rates in the country, however, varied between 11 per 100,000 in Trivandrum and 30 per 100,000 in Chennai (former Madras), all in Southern India. 2 In Chennai, a woman's estimated probability of developing cervical cancer up to age 74 was more than 3%. As in other developing countries, squamous cell carcinoma predominates, whereas adenocarcinoma of the cervix accounts for a small percent of all cervical cancer, even in the urban areas (e.g., Mumbai, 7%). 3 A high prevalence of human papillomavirus (HPV) 16 and 18 in cervical cancer specimens has been shown in India 2 as elsewhere, 4 but limited information is available on the distribution of HPV types in the country.Case-control studies on invasive cervical carcinoma (ICC) in India have been relatively few. 6 -11 Low educational and socioeconomic level, young age at marriage or first sexual intercourse, high parity and male partner's sexual behaviour were the most consistently reported risk factors. No case-control study from India has provided thus far an estimate of the association between cervical cancer and infection with HPV, the necessary cause of the disease worldwide. 12 To further elucidate the role of different HPV types and its co-factors in ICC aetiology, we carried out a case-control study in Chennai, Southern India. MATERIAL AND METHODSOur study is part of an international multicenter case-control study of ICC and HPV coordinated by the International Agency for Research on Cancer (IARC). 13 From June 1998 to May 1999, 222 women with a diagnosis of ICC were recruited into the Cancer Institute in Chennai, Southern India. 14 On account of the high burden of ICC cases at the Cancer Institute, the first woman to be newly diagnosed with ICC each working day was asked to participate in our study and was administered an informed consent. Inclusion criteria for case subjects were: (i) histologic confirmation of ICC diagnosis; (ii) no previous cancer treatment; and (iii) lack of physical or mental impairments that would have made the interview impossible. Seventeen women were excluded based on the revision of histol...

Cervical carcinoma in Algiers, Algeria: Human papillomavirus and lifestyle risk factors

“…3 Overall, these findings suggest that the distribution of HPV types in CC from north Africa resembles more closely the distribution found in similar studies in Europe and North America than that found in the rest of the African continent, where HPV 16 accounts for less that 50% of HPV positivity. 12 As in most previous work, 7,13 infection with multiple HPV types did not confer an increased risk compared to single-type infection.…”

“…While 90% of CC cases had never had a Pap smear, 1/3 of control women did report having had at least one (i.e., a nonnegligible proportion compared to many developing countries). 13 With respect to indicators of sexual habits, the association with age at first sexual intercourse and number of sexual partners was found as expected, but risk trends did not reach statistical significance. Only 10% of CC cases and 5% of control women reported 3 lifetime sexual partners or more.…”

Socio Demographic and Reproductive Risk Factors for Cervical Cancer - a Large Prospective Cohort Study from Rural India

“…The results from a case control study in Chennai showed that high parity (>4 vs. ≤ 2 births) was associated with invasive cervical cancer (OR=7.3) after restricting the analysis to HPV positive women (Franceschi et al, 2003). Birth interval or the rapidity of multiple pregnancies also has an independent influence on the risk for cervical cancer (Mukherjee et al, 1994).…”

Detection of human papillomavirus in women attending Pap cervical screening camp at a peripheral hospital of North-Eastern India

“…All the present study subjects were married, 85% of them being sexually active and younger than 35 years of age (this age-group is known to have high incidence of transient HPV infection), 84% reported early age of marriage/sexual intercourse (16e22 years, median 19 years), more than 95% had one or more pregnancies (range 1e6, median-2), younger age at child birth, etc., that may influence HPV infection risk significantly. 2,10,12 We acknowledge that due to the cross-sectional nature of the present study, we could not resolve the issue of transient infection. Nevertheless, considering the risk factors, HPV prevalence differs considerably from previous studies and is not generalizable to other populations.…”

“…2,9 Same is true for HPV also, as its prevalence varies greatly across India. 2,4,10 Among asymptomatic population, normally 10e12% to as high as 64% HPV prevalence has been reported from certain parts of India. 2,11 Moreover, HPV 16 is predominant in India, detectable in 22% of general population, while ranging from w14 to 88% in cervical cancer population.…”