title: Evidence for Chlamydia trachomatis as a human papillomavirus cofactor in the etiology of invasive cervical cancer in Brazil and the Philippines.
abstract: Chlamydia trachomatis infection was examined as a cause of invasive cervical cancer (ICC) among women with human papillomavirus (HPV) infection. In total, 499 women with incident ICC (ICC patients) and 539 control patients from São Paulo, Brazil, and Manila, the Philippines, were included. C. trachomatis antibodies were detected by microimmunofluorescence assay. Presence of HPV DNA in cervical specimens was determined by a polymerase chain reaction-based assay. C. trachomatis seropositivity was associated with sexual behavior but not with HPV infection. C. trachomatis increased the risk of squamous cervical cancer among HPV-positive women (odds ratio, 2.1; 95% confidence interval, 1.1-4.0). Results were similar in both countries. There was a suggestion of increasing squamous cancer risk with increasing C. trachomatis antibody titers. This large study examined C. trachomatis and cervical cancer, taking into account the central role of HPV infection. C. trachomatis infection was found to be a possible cofactor of HPV in the etiology of squamous cervical cancer, and its effect may be mediated by chronic inflammation.
authors.affiliation: International Agency for Research on Cancer, F-69372 Lyon Cédex 08, France. smith@iarc.fr
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
authors.forename: Nubia
authors.initials: N
authors.lastname: Muñoz
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
authors.forename: José
authors.initials: J
authors.lastname: Eluf-Neto
authors.forename: Corazon
authors.initials: C
authors.lastname: Ngelangel
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Bosch
authors.forename: Jan M M
authors.initials: JM
authors.lastname: Walboomers
authors.forename: Rosanna W
authors.initials: RW
authors.lastname: Peeling
mesh_terms: D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D001938:Brazil; D002690:Chlamydia Infections / Q000150:complications*; D002692:Chlamydia trachomatis / Q000276:immunology / Q000302:isolation & purification*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications*; D010679:Philippines; D016036:Seroepidemiologic Studies; D014412:Tumor Virus Infections / Q000150:complications*; D002583:Uterine Cervical Neoplasms / Q000209:etiology* / Q000821:virology
chemical_list: D000907:Antibodies, Bacterial; D004279:DNA, Viral