Sexual Behavior, Sexually Transmitted Diseases, and Risk of Cervical Cancer

Stone, Katherine M.; Zaidi, Akbar A.; Rosero-Bixby, Luis; Oberle, Mark W.; Reynolds, Gladys H.; Larsen, Sandra A.; Nahmias, André J.; Lee, Francis K.; Schachter, Julius; Guinan, Mary

doi:10.1097/00001648-199507000-00014

Cited by 57 publications

(37 citation statements)

References 28 publications

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“…Among studies that contributed to the present collaborative reanalysis, four cohort studies did not include information on sexual behavior (25)(26)(27)(28). Findings on sexual behavior have been published from eight studies that were not included and were consistent with our present results (14,(16)(17)(18)(19)(20)(21)(22)(23).…”

Section: Discussionsupporting

confidence: 69%

“…When conditioning on sexual factors (i.e., lifetime number of sexual partners, age at first intercourse), the broad classification of 1, 2-5, and z6 was used for lifetime number of sexual partners, and single years were used for age at first intercourse in the range 15 to 24 years, with additional categories of V14 years and z25 years for women outside of this range. When conditioning on reproductive factors [i.e., number of full-term pregnancies (FTP) and age at first FTP], the number of FTPs was categorized as 0, 1-2, 3-4, and z5, and age at first FTP was categorized as <17, [17][18][19][20][21][22][23][24] …”

Section: Methodsmentioning

confidence: 99%

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Cervical Carcinoma and Sexual Behavior: Collaborative Reanalysis of Individual Data on 15,461 Women with Cervical Carcinoma and 29,164 Women without Cervical Carcinoma from 21 Epidemiological Studies

Tajkumar¹,

Cuzick²,

Appleby³

et al. 2009

Cancer Epidemiology, Biomarkers &Amp; Prevention

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High-risk human papillomavirus (HPV) types cause most cervical carcinomas and are sexually transmitted. Sexual behavior therefore affects HPV exposure and its cancer sequelae. The International Collaboration of Epidemiological Studies of Cervical Cancer has combined data on lifetime number of sexual partners and age at first sexual intercourse from 21 studies, or groups of studies, including 10,773 women with invasive cervical carcinoma, 4,688 women with cervical intraepithelial neoplasia grade 3 (CIN3)/carcinoma in situ, and 29,164 women without cervical carcinoma. Relative risks for invasive cancer and CIN3 were estimated by conditional logistic regression. Risk of invasive cervical carcinoma increased with lifetime number of sexual partners (P for linear trend <0.001). The relative risk for z6 versus 1 partner, conditioned on age, study, and age at first intercourse, was 2.27 [95% confidence interval (95% CI), 1.98-2.61] and increased to 2.78 (95% CI, 2.22-3.47) after additional conditioning on reproductive factors. The risk of invasive cervical carcinoma increased with earlier age at first intercourse (P for linear trend <0.001). The relative risk for age at first intercourse V14 versus z25 years, conditioned on age, study, and lifetime number of sexual partners was 3.52 (95% CI, 3.04-4.08), which decreased to 2.05 (95% CI, 1.54-2.73) after additional conditioning on reproductive factors. CIN3/carcinoma in situ showed a similar association with lifetime number of sexual partners; however, the association with age at first intercourse was weaker than for invasive carcinoma. Results should be interpreted with caution given the strong correlation between sexual and reproductive factors and the limited information on HPV status.

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Section: Discussionsupporting

confidence: 69%

Section: Methodsmentioning

confidence: 99%

Cervical Carcinoma and Sexual Behavior: Collaborative Reanalysis of Individual Data on 15,461 Women with Cervical Carcinoma and 29,164 Women without Cervical Carcinoma from 21 Epidemiological Studies

Tajkumar¹,

Cuzick²,

Appleby³

et al. 2009

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Data could not be retrieved for 10 published studies [14][15][16][17][18][19][20][21][22][23][24] and 1 research group 25 declined to take part in the collaboration. Of the studies identified, original data were available from 25,6, and all had information on reproductive factors and were therefore included in the present collaborative reanalysis (Table I).…”

Section: Resultsmentioning

confidence: 99%

“…The results of these studies were consistent with our present results. 16,17,19,[21][22][23][24] The difficulty of disentangling the effect of reproductive variables from sexual behaviour and HPV infection cannot, however, be overstated. If the number of sexual partners is inaccurately reported, or information on some potentially relevant aspects of sexual behaviour (e.g., husband's sexual behaviour in our present reanalysis) is not available, a residual confounding effect cannot be completely ruled out.…”

Section: Discussionmentioning

confidence: 99%

Cervical carcinoma and reproductive factors: Collaborative reanalysis of individual data on 16,563 women with cervical carcinoma and 33,542 women without cervical carcinoma from 25 epidemiological studies

Rajkumar

Cuzick

Appleby

et al. 2006

Intl Journal of Cancer

195

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Cervical carcinoma and reproductive factors: Collaborative reanalysis of individual data on 16,563 women with cervical carcinoma and 33,542 women without cervical carcinoma from 25 epidemiological studies International Collaboration of Epidemiological Studies of Cervical CancerThe International Collaboration of Epidemiological Studies of Cervical Cancer has combined individual data on 11,161 women with invasive carcinoma, 5,402 women with cervical intraepithelial neoplasia (CIN)3/carcinoma in situ and 33,542 women without cervical carcinoma from 25 epidemiological studies. Relative risks (RRs) and 95% confidence intervals (CIs) of cervical carcinoma in relation to number of full-term pregnancies, and age at first fullterm pregnancy, were calculated conditioning by study, age, lifetime number of sexual partners and age at first sexual intercourse. Number of full-term pregnancies was associated with a risk of invasive cervical carcinoma. After controlling for age at first fullterm pregnancy, the RR for invasive cervical carcinoma among parous women was 1.76 (95% CI: 1.53-2.02) for 7 full-term pregnancies compared with 1-2. For CIN3/carcinoma in situ, no significant trend was found with increasing number of births after controlling for age at first full-term pregnancy among parous women. Early age at first full-term pregnancy was also associated with risk of both invasive cervical carcinoma and CIN3/carcinoma in situ. After controlling for number of full-term pregnancies, the RR for first full-term pregnancy at age <17 years compared with 25 years was 1.77 (95% CI: 1.42-2.23) for invasive cervical carcinoma, and 1.78 (95% CI: 1.26-2.51) for CIN3/carcinoma in situ. Results were similar in analyses restricted to high-risk human papilloma virus (HPV)-positive cases and controls. No relationship was found between cervical HPV positivity and number of fullterm pregnancies, or age at first full-term pregnancy among controls. Differences in reproductive habits may have contributed to differences in cervical cancer incidence between developed and developing countries. ' 2006 Wiley-Liss, Inc.Key words: cervical carcinoma; cervical intraepithelial neoplasia; reproductive factors; full-term pregnancy; age at first full-term pregnancy; collaborative reanalysis; relative risk Parity was one of the earliest risk factors to be associated with cancer risk. Already in 1842, on the basis of death certificates in Verona, Italy, Rigoni-Stern observed that cancers of the uterus (which at that time chiefly originated from the cervix) were more frequent in married women, who tended to be multiparous, whereas breast neoplasms were more common in nulliparae, including nuns. 1Epidemiological studies conducted in the 1950's and 1960's pointed to sexual habits, and subsequent studies to sexual infections, specifically high-risk human papillomavirus (HPV) types, 2 as the key factor in cervical carcinogenesis. Consequently, they tended to consider that the association between reproductive factors and cervical cancer was chiefly accounted for by...

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“…Seven case-control studies were eligible but were not included because the data were not available. [40][41][42][43][44][45][46] RRs and CIs were published for 4 of these studies and the summary RR for current smoking was 1.73 (95% CI: 1.21-2.46). Since the results from the studies that were not included were broadly similar to the findings from those studies that were included, their omission is unlikely to have biased the results presented here.…”

Section: Discussionmentioning

confidence: 99%

Carcinoma of the cervix and tobacco smoking: Collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies

2005

Int. J. Cancer

349

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Carcinoma of the cervix and tobacco smoking: Collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies International Collaboration of Epidemiological Studies of Cervical Cancer* Tobacco smoking has been classified as a cause of cervical cancer, but the effect of different patterns of smoking on risk is unclear. The International Collaboration of Epidemiological Studies of Cervical Cancer has brought together and combined individual data on 13,541 women with and 23,017 women without cervical carcinoma, from 23 epidemiological studies. Relative risks (RRs) and 95% confidence intervals (CIs) of carcinoma of the cervix in relation to tobacco smoking were calculated with stratification by study, age, sexual partners, age at first intercourse, oral contraceptive use and parity. Current smokers had a significantly increased risk of squamous cell carcinoma of the cervix compared to never smokers (RR 5 1.60 (95% CI: 1.48-1.73), p<0.001). There was increased risk for past smokers also, though to a lesser extent (RR 5 1.12 (1.01-1.25)), and there was no clear trend with time since stopping smoking (p-trend 5 0.6). There was no association between smoking and adenocarcinoma of the cervix (RR 5 0.89 (0.74-1.06) and 0.89 (0.72-1.10) for current and past smokers respectively), and the differences between the RRs for smoking and squamous cell and adenocarcinoma were statistically significant (current smoking p<0.001 and past smoking p 5 0.01). In current smokers, the RR of squamous cell carcinoma increased with increasing number of cigarettes smoked per day and also with younger age at starting smoking (p<0.001 for each trend), but not with duration of smoking (p-trend 5 0.3). Eight of the studies had tested women for cervical HPV-DNA, and in analyses restricted to women who tested positive, there was a significantly increased risk in current compared to never smokers for squamous cell carcinoma (RR 5 1.95 (1.43-2.65)), but not for adenocarcinoma (RR 5 1.06 (0.14-7.96)). In summary, smokers are at an increased risk of squamous cell but not of adenocarcinoma of the cervix. The risk of squamous cell carcinoma increases in current smokers with the number of cigarettes smoked per day and with younger age at starting smoking. ' 2005 Wiley-Liss, Inc.Key words: tobacco; cervical cancer; risk; meta-analysis Cervical infection with high-risk types of human papillomavirus (HPV) is the main cause of most cervical cancers. Although many women get infected with this virus, most do not go on to develop cervical cancer. A number of other factors, such as tobacco smoking, are therefore thought to be involved in the disease process. The International Agency for Research on Cancer (IARC) has classified tobacco smoking as a cause of cervical cancer.1 However, it remains unclear how different patterns of use, such as amount smoked or duration of smoking, affect a woman's risk of developing cervical cancer. Data on individual women from a...

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Sexual Behavior, Sexually Transmitted Diseases, and Risk of Cervical Cancer

Cited by 57 publications

References 28 publications

Cervical Carcinoma and Sexual Behavior: Collaborative Reanalysis of Individual Data on 15,461 Women with Cervical Carcinoma and 29,164 Women without Cervical Carcinoma from 21 Epidemiological Studies

Cervical Carcinoma and Sexual Behavior: Collaborative Reanalysis of Individual Data on 15,461 Women with Cervical Carcinoma and 29,164 Women without Cervical Carcinoma from 21 Epidemiological Studies

Cervical carcinoma and reproductive factors: Collaborative reanalysis of individual data on 16,563 women with cervical carcinoma and 33,542 women without cervical carcinoma from 25 epidemiological studies

Carcinoma of the cervix and tobacco smoking: Collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies

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