Is smoking an independent risk factor for invasive cervical cancer? A nested case-control study within Nordic biobanks.
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.
Kapeu
Aline Simen
AS
National Public Health Institute, P.O. Box 310, 90101 Oulu, Finland. kapeu_aline@yahoo.fr
Luostarinen
Tapio
T
Jellum
Egil
E
Dillner
Joakim
J
Hakama
Matti
M
Koskela
Pentti
P
Lenner
Per
P
Löve
Arthur
A
Mahlamaki
Eija
E
Thoresen
Steinar
S
Tryggvadóttir
Laufey
L
Wadell
Göran
G
Youngman
Linda
L
Lehtinen
Matti
M
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*
D015415:Biomarkers; D007074:Immunoglobulin G; D003367:Cotinine