title: Socio demographic and reproductive risk factors for cervical cancer - a large prospective cohort study from rural India.
abstract: BACKGROUND
  India shows some of the highest rates of cervical cancer worldwide, and more than 70% of the population is living in rural villages. Prospective cohort studies to determine the risk factors for cervical cancer are very rare from low and medium resource countries. The aim of this study was to quantify the effect of risk factors related to cervical cancer in a rural setting in South India.
  
  
  METHODS
  Sociodemographic and reproductive potential risk factors for cervical cancer were studied using the data from a cohort of 30,958 women who constituted the unscreened control group in a randomised screening trial in Dindigul district, Tamilnadu, India. The analysis was accomplished with the Cox proportional hazard regression model.
  
  
  RESULTS
  Women of increasing age (HR=2.4; 95% CI: 1.6, 3.8 in 50-59 vs 30-39), having many pregnancies (HR=7.1; 1.0, 52 in 4+ vs 0) and no education (HR=0.6; 0.2, 0.7 in high vs none) were found to be at significantly increased risk of cervical cancer.
  
  
  CONCLUSIONS
  This cohort study gives very strong evidence to say that education is the fundamental factor among the sociodemographic and reproductive determinants of cervical cancer in low resource settings. Public awareness through education and improvements in living standards can play an important role in reducing the high incidence of cervical cancer in India. These findings further stress the importance of formulating public health policies aimed at increasing awareness and implementation of cervical cancer screening programmes.
authors.affiliation: Achutha Menon Centre for Health Sciences Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) Trivandrum, India. jissa@sctimst.ac.in
authors.forename: Jissa V
authors.initials: JV
authors.lastname: Thulaseedharan
authors.forename: Nea
authors.initials: N
authors.lastname: Malila
authors.forename: Matti
authors.initials: M
authors.lastname: Hakama
authors.forename: Pulikottil O
authors.initials: PO
authors.lastname: Esmy
authors.forename: Mary
authors.initials: M
authors.lastname: Cheriyan
authors.forename: Rajaraman
authors.initials: R
authors.lastname: Swaminathan
authors.forename: Richard
authors.initials: R
authors.lastname: Muwonge
authors.forename: Rengaswami
authors.initials: R
authors.lastname: Sankaranarayanan
mesh_terms: D052685:Alphapapillomavirus; D015331:Cohort Studies; D003710:Demography; D055088:Early Detection of Cancer; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology; D008403:Mass Screening; D030361:Papillomavirus Infections; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D017584:Reproductive History; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control