title: Smoking as a major risk factor for cervical cancer and pre-cancer: results from the EPIC cohort.
abstract: A total of 308,036 women were selected from the European Prospective Investigation into Cancer and Nutrition (EPIC) study to evaluate the association between tobacco smoking and the risk of cervical intraepithelial neoplasia of grade 3 (CIN3)/carcinoma in situ (CIS) and invasive cervical cancer (ICC). At baseline, participants completed a questionnaire and provided blood samples. During a mean follow-up time of 9 years, 261 ICC cases and 804 CIN3/CIS cases were reported. In a nested case-control study, the baseline sera from 609 cases and 1,218 matched controls were tested for L1 antibodies against HPV types 11, 16, 18, 31, 33, 35, 45, 52, 58, and antibodies against Chlamydia trachomatis (CT), and Human Herpes Virus 2 (HHV-2). Cervical samples were not available for HPV-DNA analysis in this study. Multivariate analyses were used to estimate associations between smoking and risk of CIN3/CIS and ICC in the cohort and the case-control studies. In the cohort analyses smoking status, duration and intensity showed a two-fold increased risk of CIN3/CIS and ICC, while time since quitting was associated with a two-fold reduced risk. In the nested case-control study, consistent associations were observed after adjustment for HPV, CT and HHV-2 serostatus, in both HPV seronegative and seropositive women. Results from this large prospective study confirm the role of tobacco smoking as an important risk factor for both CIN3/CIS and ICC, even after taking into account HPV exposure as determined by HPV serology. The strong beneficial effect of quitting smoking is an important finding that will further support public health policies for smoking cessation.
authors: Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors: Esther
authors: E
authors: Roura
authors: Xavier
authors: X
authors: Castellsagué
authors: Michael
authors: M
authors: Pawlita
authors: Noémie
authors: N
authors: Travier
authors: Tim
authors: T
authors: Waterboer
authors: Núria
authors: N
authors: Margall
authors: F Xavier
authors: FX
authors: Bosch
authors: Silvia
authors: S
authors: de Sanjosé
authors: Joakim
authors: J
authors: Dillner
authors: Inger T
authors: IT
authors: Gram
authors: Anne
authors: A
authors: Tjønneland
authors: Christian
authors: C
authors: Munk
authors: Valeria
authors: V
authors: Pala
authors: Domenico
authors: D
authors: Palli
authors: Kay-Tee
authors: KT
authors: Khaw
authors: Ruanne V
authors: RV
authors: Barnabas
authors: Kim
authors: K
authors: Overvad
authors: Françoise
authors: F
authors: Clavel-Chapelon
authors: Marie-Christine
authors: MC
authors: Boutron-Ruault
authors: Guy
authors: G
authors: Fagherazzi
authors: Rudolf
authors: R
authors: Kaaks
authors: Annekatrin
authors: A
authors: Lukanova
authors: Annika
authors: A
authors: Steffen
authors: Antonia
authors: A
authors: Trichopoulou
authors: Dimitrios
authors: D
authors: Trichopoulos
authors: Eleni
authors: E
authors: Klinaki
authors: Rosario
authors: R
authors: Tumino
authors: Carlotta
authors: C
authors: Sacerdote
authors: Salvatore
authors: S
authors: Panico
authors: H B As
authors: HB
authors: Bueno-de-Mesquita
authors: Petra H
authors: PH
authors: Peeters
authors: Eiliv
authors: E
authors: Lund
authors: Elisabete
authors: E
authors: Weiderpass
authors: M Luisa
authors: ML
authors: Redondo
authors: María-José
authors: MJ
authors: Sánchez
authors: Maria-José
authors: MJ
authors: Tormo
authors: Aurelio
authors: A
authors: Barricarte
authors: Nerea
authors: N
authors: Larrañaga
authors: Johanna
authors: J
authors: Ekström
authors: Maria
authors: M
authors: Hortlund
authors: David
authors: D
authors: Lindquist
authors: Nick
authors: N
authors: Wareham
authors: Ruth C
authors: RC
authors: Travis
authors: Sabina
authors: S
authors: Rinaldi
authors: Massimo
authors: M
authors: Tommasino
authors: Silvia
authors: S
authors: Franceschi
authors: Elio
authors: E
authors: Riboli
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000209:etiology*; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000209:etiology*
keywords: EPIC; Human Papillomavirus serology; cervical cancer; cohort study; smoking