Huilan Xu1, Sam Egger2, Louiza S Velentzis3, Dianne L O'Connell4, Emily Banks5, Jessica Darlington-Brown2, Karen Canfell6, Freddy Sitas7. 1. Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia. 2. Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, NSW, Australia. 3. Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, NSW, Australia; Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia. 4. Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia; Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Australia. 5. National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia; The Sax Institute, Sydney, Australia. 6. Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia; Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, NSW, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia. Electronic address: karen.canfell@nswcc.org.au. 7. Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia; School of Public Health and Community Medicine, University of New South Wales Australia, Kensington, Australia.
Abstract
BACKGROUND: Human papillomavirus (HPV) vaccines protect against HPV types 16/18, but do not eliminate the need to detect pre-cancerous lesions. Australian women vaccinated as teenage girls are now entering their mid-thirties. Since other oncogenic HPV types have been shown to be more prevalent in women ≥30 years old, understanding high grade cervical lesions in older women is still important. Hormonal contraceptives (HC) and smoking are recognised cofactors for the development of pre-malignant lesions. METHODS: 886 cases with cervical intraepithelial neoplasia (CIN) 2/3 and 3636 controls with normal cytology were recruited from the Pap Test Register of NSW, Australia. All women were aged 30-44 years. Conditional logistic regression was used to quantify the relationship of HC and smoking to CIN 2/3 adjusted for various factors. RESULTS: Current-users of HC were at higher risk for CIN 2/3 than never-users [odds ratio (OR) = 1.50, 95%CI = 1.03-2.17] and risk increased with increasing duration of use [ORs:1.13 (0.73-1.75), 1.51 (1.00-2.72), 1.82 (1.22-2.72) for <10, 10-14, ≥15 years of use; p-trend = 0.04]. Ex-users had risks similar to never-users (OR 1.08, 95%CI = 0.75-1.57) regardless of duration of use. Current smoking was significantly associated with CIN 2/3 (OR = 1.43, 95%CI = 1.14-1.80) and risk increased with increasing number of cigarettes/day (p-trend = 0.02). Among ex-smokers, the risk of CIN 2/3 decreased with increasing time since quitting (p-trend = 0.04). CONCLUSIONS: In this benchmark study, current, long term users of HC and current smokers of ≥5 cigarettes/day were each at increased risk of developing CIN 2/3. Findings support smoking cessation in relation to decreasing the risk of pre-cancerous lesions and reinforce the continuing need for cervical screening for cancer prevention in vaccinated and unvaccinated populations.
BACKGROUND:Human papillomavirus (HPV) vaccines protect against HPV types 16/18, but do not eliminate the need to detect pre-cancerous lesions. Australian women vaccinated as teenage girls are now entering their mid-thirties. Since other oncogenic HPV types have been shown to be more prevalent in women ≥30 years old, understanding high grade cervical lesions in older women is still important. Hormonal contraceptives (HC) and smoking are recognised cofactors for the development of pre-malignant lesions. METHODS: 886 cases with cervical intraepithelial neoplasia (CIN) 2/3 and 3636 controls with normal cytology were recruited from the Pap Test Register of NSW, Australia. All women were aged 30-44 years. Conditional logistic regression was used to quantify the relationship of HC and smoking to CIN 2/3 adjusted for various factors. RESULTS: Current-users of HC were at higher risk for CIN 2/3 than never-users [odds ratio (OR) = 1.50, 95%CI = 1.03-2.17] and risk increased with increasing duration of use [ORs:1.13 (0.73-1.75), 1.51 (1.00-2.72), 1.82 (1.22-2.72) for <10, 10-14, ≥15 years of use; p-trend = 0.04]. Ex-users had risks similar to never-users (OR 1.08, 95%CI = 0.75-1.57) regardless of duration of use. Current smoking was significantly associated with CIN 2/3 (OR = 1.43, 95%CI = 1.14-1.80) and risk increased with increasing number of cigarettes/day (p-trend = 0.02). Among ex-smokers, the risk of CIN 2/3 decreased with increasing time since quitting (p-trend = 0.04). CONCLUSIONS: In this benchmark study, current, long term users of HC and current smokers of ≥5 cigarettes/day were each at increased risk of developing CIN 2/3. Findings support smoking cessation in relation to decreasing the risk of pre-cancerous lesions and reinforce the continuing need for cervical screening for cancer prevention in vaccinated and unvaccinated populations.
Authors: Joanne M Michaud; Tingting Zhang; Theresa I Shireman; Yoojin Lee; Ira B Wilson Journal: Cancer Epidemiol Biomarkers Prev Date: 2020-05-08 Impact factor: 4.090