title: Factors associated with the risk of progression to precursor lesions or cervical cancer in women with negative cytologic findings.
abstract: OBJECTIVE
  To evaluate factors associated with progression to cervical cancer or moderate to severe precursor lesions (cervical intraepithelial neoplasia grade 2 [CIN 2] or higher) in women with negative cervical screening results.
  
  
  METHODS
  A cohort of 1236 women from the state of Rio de Janeiro, Brazil, was followed up for 36 months. Hazards ratios (HR) and related 95% confidence intervals (CIs) were calculated, and the Cox proportional hazards model was used to evaluate factors associated with the development of lesions grade CIN 2 or higher.
  
  
  RESULTS
  After adjusting for age, education level, number of sexual partners, and parity, the presence of CIN 2 or more advanced lesions was associated with HPV infection (HR, 39.0; 95% CI, 9.8-156.0), smoking (HR, 7.7; 95% CI, 2.0-29.6), and early age at first sexual intercourse (HR, 4.1; 95% CI, 1.1-15.1).
  
  
  CONCLUSIONS
  These findings suggest that women at increased risk for cervical cancer be screened for HPV at the time of cervical screening, particularly in areas where access to health services is difficult. Antismoking strategies especially targeting young women should be a priority in a comprehensive women's health care program.
authors.affiliation: Institute for Social Medicine (IMS), Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil. vaniagirianelli@yahoo.com.br
authors.forename: Vania Reis
authors.initials: VR
authors.lastname: Girianelli
authors.forename: Gulnar
authors.initials: G
authors.lastname: Azevedo E Silva
authors.forename: Luiz Claudio Santos
authors.initials: LC
authors.lastname: Thuler
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000473:pathology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012725:Sexual Behavior; D012907:Smoking; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology*