HPV co-factors related to the development of cervical cancer: results from a population-based study in Costa Rica.
We examined factors associated with high-grade squamous intraepithelial lesions (HSIL) and cervical cancer among human papillomavirus (HPV)-infected women in a prevalent case-control study conducted within a population-based cohort of 10 077 women in Costa Rica. We compared 146 women with HPV-positive HSIL or cancer (HSIL/CA) against 843 HPV-positive women without evidence of HSIL/CA. Subjects completed a risk factor questionnaire. We evaluated the associations between exposures and HSIL/CA among women positive for any HPV and restricted to those positive for high-risk HPV types. Risk of HSIL/CA increased with increasing number of live births (P(trend)= 0.04). Women who smoked 6+ cigarettes/day had a RR for HSIL/CA of 2.7 (95% CI = 1.1-6.7) compared to non-smokers. Current use of barrier contraceptives was associated with a reduction in risk of HSIL/CA (RR = 0.39; 95% CI = 0.16-0.96). Sexual behaviour and a self-reported history of sexually transmitted diseases (STDs) other than HPV were not associated with HSIL/CA. Oral contraceptive use was associated with HSIL/CA among women with <3 pregnancies. Effects were similar in analysis restricted to women positive for high-risk HPV types. Among women positive for high-risk HPV types, 44% of HSIL/CA could be attributed to multiparity (>/=3 pregnancies) and/or smoking. Among HPV-positive women, multiparity and smoking are risk factors for HSIL/CA. Oral contraceptive use may be associated with HSIL/CA in subgroups of women.
Hildesheim
A
A
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Herrero
R
R
Castle
P E
PE
Wacholder
S
S
Bratti
M C
MC
Sherman
M E
ME
Lorincz
A T
AT
Burk
R D
RD
Morales
J
J
Rodriguez
A C
AC
Helgesen
K
K
Alfaro
M
M
Hutchinson
M
M
Balmaceda
I
I
Greenberg
M
M
Schiffman
M
M
D000293:Adolescent; D000328:Adult; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000209:etiology / Q000821:virology*; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology / Q000821:virology*; D016022:Case-Control Studies; D003364:Costa Rica / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D027383:Papillomaviridae / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000150:complications*; D010298:Parity; D012307:Risk Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000150:complications; D012907:Smoking / Q000009:adverse effects; D014412:Tumor Virus Infections / Q000150:complications*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000821:virology*