Cigarette smoking and human papillomavirus in patients with reported cervical cytological abnormality.
OBJECTIVE
To assess the relation between two risk factors for cervical neoplasia: smoking and infection with oncogenic human papillomavirus. It has been suggested that smoking causes a local immunological defect, which could facilitate the infection and persistence of human papillomavirus.


METHODS
Cross sectional epidemiological study. Completion of a structured questionnaire by the patients, analysis of cervical scrapes for human papillomavirus, and morphological examination of biopsy specimens.


METHODS
Outpatient gynaecological clinic.


METHODS
181 women with a report of cervical cytological abnormality.


METHODS
Prevalence of infection with oncogenic human papillomavirus and smoking habits.


RESULTS
Oncogenic human papillomavirus was found in the cervix of 26 (41%) of the 63 women who did not smoke, 22 (58%) of the 38 who smoked 1-10 cigarettes a day, 28 (61%) of the 46 who smoked 11-20 cigarettes a day, and 26 (76%) of the 34 who smoked > or = 21 cigarettes a day. The prevalence of the virus thus increased in accordance with the number of cigarettes smoked (p = 0.001). This relation remained after adjustment for age at first intercourse and lifetime number of sexual partners. Of the 63 non-smokers, 23 had previously smoked at least 10 cigarettes a day at some time. Of these 23 women, 14 (61%) had oncogenic human papillomavirus in their cervix. Of the 40 women who had never smoked at least 10 cigarettes a day, 12 (30%) had the virus. The prevalence of oncogenic human papillomavirus in non-smokers therefore depended on previous smoking habits (p = 0.03).


CONCLUSIONS
The dose dependent effect of cigarette smoking on the occurrence of oncogenic human papillomavirus favours a causal relation between these risk factors for cervical neoplasia.
Department of Obstetrics and Gynaecology, University Hospital, Groningen, Netherlands.
M P
MP
Burger
H
H
Hollema
A S
AS
Gouw
W J
WJ
Pieters
W G
WG
Quint
D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D027383:Papillomaviridae; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology / Q000473:pathology; D014412:Tumor Virus Infections / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000209:etiology*