title: Risk factors for high-risk human papillomavirus infection and cofactors for high-grade cervical disease in Peru.
abstract: OBJECTIVE
  To evaluate the association between potential risk factors for high-risk human papillomavirus (HR-HPV) infection and cofactors for cervical intraepithelial lesions grade 2 or worse (CIN2+) in women attending cervical screening in Amazonian Peru.
  
  
  METHODS
  Participants completed a risk factor questionnaire before screening. High-risk human papillomavirus infection was determined by Hybrid Capture II. Logistic regression was used to evaluate associations between potential risk factors for HR-HPV infection and between cofactors and risk of CIN2+ among women with HR-HPV infection.
  
  
  RESULTS
  Screening and questionnaires were completed by 5435 women aged 25 to 49 years. The prevalence of HR-HPV was 12.6% (95% confidence interval [CI], 11.8%-13.6%) and decreased by age. Early age at first sexual intercourse and several lifetime sexual partners increased the risk of having HR-HPV (age-adjusted odds ratio [AOR] of age at first sexual intercourse <18 vs ≥20, 1.5; 95% CI, 1.2-2.0; AOR of ≥5 lifetime sexual partners vs 1, 2.1; 95% CI, 1.4-3.2). Among women with HR-HPV infection, those with no schooling (AOR relative to 1-5 years of schooling, 3.2; 95% CI, 1.3-8.3) and those with parity ≥3 (AOR relative to parity <3, 2.6; 95% CI, 1.4-4.9) were at increased risk of CIN2+. The effect of parity was stronger for cancer (AOR of parity ≥3 vs <3, 8.3; 95% CI, 1.0-65.6). Further analysis showed that the association between parity and CIN2+ was restricted to women younger than 40. Most women (83%) had previously been screened. Sixty-four percent of CIN2+ cases detected in this study occurred in women who reported having had a Papanicolaou test in the previous 3 years. Only 4 of 20 cancers were detected in women never screened before. Having had a previous abnormal Papanicolaou test increased the risk of CIN2+ (OR, 16.1; 95% CI, 6.2-41.9).
  
  
  CONCLUSIONS
  Among women with HR-HPV, high parity (in young women), no schooling, lack of good-quality screening and of adequate follow-up care are the main risk factors for high-grade cervical disease in Peru.
authors: Centre for Cancer Prevention, Queen Mary University of London Wolfson Institute of Preventive Medicine, London, UK. m.almonte@qmul.ac.uk
authors: Maribel
authors: M
authors: Almonte
authors: Catterina
authors: C
authors: Ferreccio
authors: Miguel
authors: M
authors: Gonzales
authors: Jose Manuel
authors: JM
authors: Delgado
authors: C Hilary
authors: CH
authors: Buckley
authors: Silvana
authors: S
authors: Luciani
authors: Sylvia C
authors: SC
authors: Robles
authors: Jennifer L
authors: JL
authors: Winkler
authors: Vivien D
authors: VD
authors: Tsu
authors: Jose
authors: J
authors: Jeronimo
authors: Jack
authors: J
authors: Cuzick
authors: Peter
authors: P
authors: Sasieni
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000821:virology