title: The role of smoking and alcohol intake in the development of high-grade squamous intraepithelial lesions among high-risk HPV-positive women.
abstract: BACKGROUND
  Infection with human papillomavirus is considered a necessary factor in developing high-grade squamous intraepithelial lesions of the cervix. However, most human papillomavirus positive women do not develop high-grade squamous intraepithelial lesions and other factors may be important for this transition. The objective of the present study was to examine if smoking and alcohol intake are associated with the risk of developing high-grade squamous intraepithelial lesions in women positive for high-risk human papillomavirus types.
  
  
  METHODS
  We used baseline information on exposures on 548 high-risk human papillomavirus positive women with normal cytology, comparing 94 women who developed high-grade squamous intraepithelial lesions with 454 women who remained cytologically normal. Logistic regression was applied for statistical analysis.
  
  
  RESULTS
  Compared with never smokers, the odds ratio for high-grade squamous intraepithelial lesions among current smokers was 1.99 (95% CI: 1.21-3.28). Among current smokers, number of cigarettes, years of smoking, and early age at smoking initiation were associated with increased risk. However, when modeled simultaneously, it seemed that smoking duration and age at smoking initiation were more associated with risk of high-grade squamous intraepithelial lesions than amount of smoking. Alcohol intake was not associated with risk of high-grade squamous intraepithelial lesions among these women.
  
  
  CONCLUSIONS
  Smoking is associated with an increased risk of developing high-grade squamous intraepithelial lesions in women who are infected with oncogenic human papillomavirus.
authors.affiliation: Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Janne
authors.initials: J
authors.lastname: Tolstrup
authors.forename: Christian
authors.initials: C
authors.lastname: Munk
authors.forename: Birthe Lykke
authors.initials: BL
authors.lastname: Thomsen
authors.forename: Edith
authors.initials: E
authors.lastname: Svare
authors.forename: Adriaan J C
authors.initials: AJ
authors.lastname: van den Brule
authors.forename: Morten
authors.initials: M
authors.lastname: Grønbaek
authors.forename: Chris
authors.initials: C
authors.lastname: Meijer
authors.forename: Susanne
authors.initials: S
authors.lastname: Kjaer Krüger
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications / Q000473:pathology; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000209:etiology / Q000821:virology