title: Is smoking an independent risk factor for invasive cervical cancer? A nested case-control study within Nordic biobanks.
abstract: The strong correlation between smoking and exposure to oncogenic human papillomaviruses (HPVs) has made it difficult to verify the independent role of smoking in cervical carcinogenesis. Thus, the authors evaluated this role. Five large Nordic serum banks containing samples from more than 1,000,000 subjects were linked with nationwide cancer registries (1973-2003). Serum samples were retrieved from 588 women who developed invasive cervical cancer and 2,861 matched controls. The samples were analyzed for cotinine (a biomarker of tobacco exposure) and antibodies to HPV types 16 and 18, herpes simplex virus type 2, and Chlamydia trachomatis. Smoking was associated with the risk of squamous cell carcinoma (SCC) among HPV16- and/or HPV18-seropositive heavy smokers (odds ratio=2.7, 95% confidence interval: 1.7, 4.3). A similar risk of SCC (odds ratio=3.2, 95% confidence interval: 2.6, 4.0) was found in heavy smokers after adjustment for HPV16/18 antibodies. The point estimates increased with increasing age at diagnosis and increasing cotinine level. This study confirms that smoking is an independent risk factor for cervical cancer/SCC in women infected with oncogenic HPVs. These findings emphasize the importance of cervical cancer prevention among women exposed to tobacco smoke.
authors.affiliation: National Public Health Institute, P.O. Box 310, 90101 Oulu, Finland. kapeu_aline@yahoo.fr
authors.forename: Aline Simen
authors.initials: AS
authors.lastname: Kapeu
authors.forename: Tapio
authors.initials: T
authors.lastname: Luostarinen
authors.forename: Egil
authors.initials: E
authors.lastname: Jellum
authors.forename: Joakim
authors.initials: J
authors.lastname: Dillner
authors.forename: Matti
authors.initials: M
authors.lastname: Hakama
authors.forename: Pentti
authors.initials: P
authors.lastname: Koskela
authors.forename: Per
authors.initials: P
authors.lastname: Lenner
authors.forename: Arthur
authors.initials: A
authors.lastname: Löve
authors.forename: Eija
authors.initials: E
authors.lastname: Mahlamaki
authors.forename: Steinar
authors.initials: S
authors.lastname: Thoresen
authors.forename: Laufey
authors.initials: L
authors.lastname: Tryggvadóttir
authors.forename: Göran
authors.initials: G
authors.lastname: Wadell
authors.forename: Linda
authors.initials: L
authors.lastname: Youngman
authors.forename: Matti
authors.initials: M
authors.lastname: Lehtinen
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002692:Chlamydia trachomatis / Q000276:immunology; D015986:Confounding Factors, Epidemiologic; D003367:Cotinine / Q000097:blood*; D005060:Europe / Q000453:epidemiology; D005260:Female; D018258:Herpesvirus 2, Human / Q000276:immunology; D052162:Human papillomavirus 16 / Q000276:immunology; D052161:Human papillomavirus 18 / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016015:Logistic Models; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D009857:Oncogenes; D011247:Pregnancy; D012042:Registries; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000097:blood / Q000453:epidemiology; D014412:Tumor Virus Infections / Q000150:complications*; D002583:Uterine Cervical Neoplasms / Q000097:blood / Q000453:epidemiology / Q000209:etiology*
chemical_list: D015415:Biomarkers; D007074:Immunoglobulin G; D003367:Cotinine