Parity as a cofactor for high-grade cervical disease among women with persistent human papillomavirus infection: a 13-year follow-up

Abstract

Background:Several environmental factors have been associated with increased risks for cervical cancer. We examined whether reproductive history, contraceptive use, or sexual behaviour increase the risk for cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among women with persistent human papillomavirus (HPV) infection.Methods:A population-based cohort of women participated in a personal interview and underwent a gynaecological examination at which cervical specimens were obtained for HPV DNA testing. Follow-up information (∼13 years) on cervical lesions was obtained from the Danish Pathology Data Bank. Women who had a high-risk HPV infection comprised the overall study population (n=1353). A subgroup of women with persistent high-risk HPV infection (n=312) was identified. Hazard ratios (HRs) for a diagnosis of CIN3+ and the corresponding 95% confidence intervals (CIs) were calculated.Results:Women with persistent HPV infection who had given birth had a significantly increased risk for CIN3+ (HR=1.78; 95% CI: 1.07–2.94). No association was found with pregnancy, use of intrauterine devices, or sexual behaviour. Based on small numbers, women with persistent HPV infection had a decreased risk for CIN3+ with any use of oral contraceptives (HR=0.54; 95% CI: 0.29–1.00).Conclusion:Childbirth increases the risk for subsequent CIN3+ among women with persistent HPV infection.

Incidence, mortality and risk factors of cervical cancer in the world

“…In this review study, too, delivery was observed to increase the risk of developing cervical cancer, especially among women with high risk HPV infection. In addition, no increase in pregnancy-associated risks was observed (Jensen et al, 2013). …”

Results of screening for cervical cancer among pregnant and non‐pregnant women in Brazil

“…By contrast, Jensen et al [16] found no association between age at first sexual intercourse and cervical intraepithelial neoplasia grade III. Furthermore, Vaccarella et al [22] did not observe an association between the onset of sexual activity after age 25 years and a decreased risk of HPV infection compared with women who initiated sexual activity before the age of 20 years.…”

“…Pregnancy and childbirth have been suggested to influence the natural history of cervical cancer [9,10,15,16] and the prevalence of HPV infection [17], which suggests that pregnancy is not a risk factor for an abnormal cytology test result. In addition, Lee et al [9] found no difference in overall survival between pregnant and non-pregnant women with early stage carcinoma of the cervix.…”

Scoring System and Management Algorithm Assessing the Role of Survivin Expression in Predicting Progressivity of HPV Infections in Precancerous Cervical Lesions

“…This finding is consistent with Belinson (2008), who found no significant correlation between parity and CIN. On the contrary, Jensen (2013) found the risk of developing CIN 3+ in women with persistent HPV infection who had given birth was 1.78 (95%CI 1.07-2.94). found parity was a significantly associated with impaired HPV clearance.…”