title: Genetic damage in exfoliated cells of the uterine cervix. Association and interaction between cigarette smoking and progression to malignant transformation?
abstract: OBJECTIVE
  To determine, through the micronucleus (MN) test, the cytogenetic effects of cigarette smoking on exfoliated cells from the uterine cervix in women with normal smears and women with inflammatory atypia, squamous intraepithelial lesion (SIL) (cervical intraepithelial neoplasia [CIN] 1-3) and cervical cancer.
  
  
  METHODS
  The study group consisted of 200 women divided into three subgroups: group 1 (n = 116), women periodically undergoing cervical cytology and residents of Salvador-Bahia; group II (n = 57), women residing in São Paulo and previously selected because of a possible cytopathologic test positive for such conditions as human papillomavirus infections or malignant or premalignant cervical lesions (CIN 1-3); group III (n = 27), inmates of the Tatuapé Penal Institution, São Paulo. All the women underwent cytologic and colposcopic examination, and biopsies were performed on 68 of them.
  
  
  RESULTS
  Considering the samples as a whole and using the chi(2) test for rare events, the number of MNs in smokers was significantly greater than in nonsmokers. It was also greater in women with larger exposure to smoking. The occurrence of MN was significantly lower in women with normal smears (smokers and nonsmokers) than in those showing any kind of pathologic alteration. In nonsmokers the occurrence of MN was similar between those with inflammatory atypia (IA) or low grade (L) SIL (CIN 1) and significantly higher in women with more severe lesions or high grade (H) SIL (CIN 2 and 3). Smokers with LSIL (CIN 1) showed a higher number of MNs than nonsmokers with a comparable diagnosis and smokers with IA. No differences were observed when compared with smokers with HSIL (CIN 2 and 3). MN occurrence was not associated with other risk factors for SIL or cancer development, such as age at first coitus, number of sexual partners, multiparity and use of hormonal contraceptives.
  
  
  CONCLUSIONS
  These results suggest that the mutagenic effect of cigarette smoking occurs in cervical cells and that the progression of SIL is associated with increased frequency of chromosomal damage. Moreover, the data suggest that cigarette smoking introduces an additional risk to the progression of low grade LSIL (CIN 1). MN testing would be helpful in monitoring smokers with this kind of lesion.
authors.affiliation: Department of Biological Science, University of Feira de Santana, São Paulo, Brazil.
authors.forename: E M
authors.initials: EM
authors.lastname: Cerqueira
authors.forename: C L
authors.initials: CL
authors.lastname: Santoro
authors.forename: N F
authors.initials: NF
authors.lastname: Donozo
authors.forename: B A
authors.initials: BA
authors.lastname: Freitas
authors.forename: C A
authors.initials: CA
authors.lastname: Pereira
authors.forename: R G
authors.initials: RG
authors.lastname: Bevilacqua
authors.forename: G M
authors.initials: GM
authors.lastname: Machado-Santelli
mesh_terms: D000328:Adult; D001938:Brazil; D002471:Cell Transformation, Neoplastic / Q000139:chemically induced* / Q000473:pathology; D002584:Cervix Uteri / Q000473:pathology*; D003043:Cocarcinogenesis; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D018450:Disease Progression; D004847:Epithelial Cells / Q000737:chemistry / Q000473:pathology; D005260:Female; D006801:Humans; D008679:Metaplasia; D015162:Micronucleus Tests; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000453:epidemiology; D011329:Prisoners; D017584:Reproductive History; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012907:Smoking / Q000009:adverse effects*; D014412:Tumor Virus Infections / Q000453:epidemiology; D002577:Uterine Cervical Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000139:chemically induced / Q000453:epidemiology / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology; D002575:Uterine Cervicitis / Q000453:epidemiology / Q000473:pathology; D014626:Vaginal Smears
chemical_list: D003278:Contraceptives, Oral, Hormonal