Risk factors for cervical cancer in Colombia and Spain

Abstract

A population-based case-control study of cervical cancer was conducted in Spain and Colombia to assess the relationship between cervical cancer and exposure to human papillomavirus (HPV), selected aspects of sexual and reproductive behaviour, use of oral contraceptives, screening practices and smoking. The study included 436 cases of histologically confirmed squamous-cell carcinoma and 387 age-stratified controls randomly selected from the general population that generated the cases. The presence of HPV DNA in cervical scrapes was assessed by PCR-based methods and was the strongest risk factor (OR = 23.8; 13.4-42.0). Risk estimates for any other factor were only slightly modified after adjusting for HPV status. Among women found positive for HPV DNA, only the use of oral contraceptives was a risk factor for cervical cancer (OR = 6.5; 1.3-31.4 for ever vs. never use). Patients with cervical cancer who were HPV DNA-negative retained most of the established epidemiological features of this disease. This suggests that some instances of HPV infection went undetected or that other sexually transmitted factor(s) contribute to the causation of cervical cancer. Early age at first intercourse (OR = 4.3; 2.1-9.0 for age < 16 vs. 24+) and early age at first birth (OR = 5.0; 1.8-14.2 for age < 16 vs. 24+) were associated with increased risk of cervical cancer; these effects were independent of one another. Low educational level was a risk factor (OR = 2.5; 1.6-3.9). Number of sexual partners was in our study a surrogate for HPV infection. Smoking and parity after age 24 were weakly and inconsistently associated with the risk of cervical cancer. Previous screening (OR = 0.7; 0.5-1.0) and ever having undergone a Caesarean section (OR = 0.4; 0.2-0.8) were protective factors.

Oral contraceptives and cervical cancer - further findings from the Oxford Family Planning Association contraceptive study

“…Recently, infection with some subtypes of the human papillomavirus (16 and 18 in particular) has been strongly associated with risk of invasive cervical cancer in two casecontrol studies (Bosch et al, 1992;Eluf-Neto et al, 1994). These studies, however, were conducted in settings where the prevalence of HPV infection of women was relatively high.…”

Risk Factors for Cervical Cancer in Criminal Justice Settings

“…14 Other risk factors for cervical cancer include tobacco use, 21,22 pregnancy at a young age, 23,24 parity, 25 and not receiving Pap testing. Women involved in the criminal justice system are likely to be at higher risk for cervical cancer because of a history of multiple sex partners, 26 early parity, trading sex for money or drugs, 27,28 and tobacco use.…”

HPV co-factors related to the development of cervical cancer: results from a population-based study in Costa Rica

“…Results from studies of HPV 'co-factors' suggest that reproductive factors, contraceptive use, cigarette smoking, and correlates of sexual behaviour other than HPV infection might be associated with HSIL and cervical cancer (henceforth referred to as HSIL/CA) (Bosch et al, 1992;Munoz et al, 1993;Becker et al, 1994;Moreno et al, 1995;Kjaer et al, 1996;Chaouki et al, 1998;Chichareon et al, 1998;Ho et al, 1998;Kruger-Kjaer et al, 1998;Olsen et al, 1998;Ngelangel et al, 1998;Roteli-Martins et al, 1998). In most of these studies, HPV infection was accounted for through statistical adjustment, i.e.…”