Sexual behaviour and smoking as determinants of cervical HPV infection and of CIN3 among those infected: a case–control study nested within the Manchester cohort

Abstract

To distinguish risk factors for acquisition of cervical human papillomavirus (HPV) infection from the determinants of neoplasia among infected individuals we have conducted a three-arm case-control study nested within a large population-based cohort of women (the Manchester cohort) screened for HPV at entry using L1 consensus primer PCR. The study includes 181 HPV-positive controls who did not develop high-grade cervical intraepithelial neoplasia (CIN3) during follow-up, 203 HPV-negative controls, and 199 HPV-positive cases with histologically confirmed CIN3. Detailed information on sexual, reproductive and gynaecological history, oral contraceptive use and smoking was obtained at face-to-face interview. There was a striking division between risk factors for infection and those predictive of disease. Comparing the HPV-positive against the HPV-negative controls, the only risk factors for infection were number of sexual partners (OR for six or more = 3.89; 95% Cl = 1.99-7.62), a relatively recent new sexual relationship (OR for a new partner within the previous 2 years = 4.17; 95% Cl = 2.13-8.33), and a history of previous miscarriage (OR = 2.59; 95% Cl = 1.28-5.21). The determinants of CIN3 among infected women were, in contrast, early age at first intercourse (OR for 16 years old or less = 3.23; 95% Cl = 1.33-7.69), a long time since starting a new sexual relationship (OR for 6 years or more = 4.94; 95% Cl = 2.51-9.71), and cigarette smoking, with strong evidence for a dose- response (OR for current smoking habit 20+ per day = 2.57; 95% Cl = 1.49-4.45). Oral contraceptive use was not significantly associated with either HPV infection or CIN3.

References 19

1. 1.

   Bauer H. M., Hildesheim A., Schiffman M. H., Glass A. G., Rush B. B., Scott D. R., Cadell D. M., Kurman R. J., Manos M. M. Determinants of genital human papillomavirus infection in low-risk women in Portland, Oregon. Sex Transm Dis. 1993;20(5):274-278.

   Not in our library10.1097/00007435-199309000-00007

2. 2.

   Bauer H. M., Ting Y., Greer C. E., Chambers J. C., Tashiro C. J., Chimera J., Reingold A., Manos M. M. Genital human papillomavirus infection in female university students as determined by a PCR-based method. JAMA. 1991;265(4):472-477.

   Not in our library

3. 3.

   Bosch F. X., Manos M. M., Muñoz N., Sherman M., Jansen A. M., Peto J., Schiffman M. H., Moreno V., Kurman R., Shah K. V. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst. 1995;87(11):796-802.

   Not in our library10.1093/jnci/87.11.796

4. 4.

   Evander M., Edlund K., Gustafsson A., Jonsson M., Karlsson R., Rylander E., Wadell G. Human papillomavirus infection is transient in young women: a population-based cohort study. J Infect Dis. 1995;171(4):1026-1030.

   Not in our library10.1093/infdis/171.4.1026

5. 5.

   Hildesheim A., Gravitt P., Schiffman M. H., Kurman R. J., Barnes W., Jones S., Tchabo J. G., Brinton L. A., Copeland C., Epp J. Determinants of genital human papillomavirus infection in low-income women in Washington, D.C. Sex Transm Dis. 1993;20(5):279-285.

   Not in our library10.1097/00007435-199309000-00008

6. 6.

   Hinchliffe S. A., van Velzen D., Korporaal H., Kok P. L., Boon M. E. Transience of cervical HPV infection in sexually active, young women with normal cervicovaginal cytology. Br J Cancer. 1995;72(4):943-945.

   Not in our library10.1038/bjc.1995.438

7. 7.

   Ho G. Y., Bierman R., Beardsley L., Chang C. J., Burk R. D. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998;338(7):423-428.

   Not in our library10.1056/nejm199802123380703

8. 8.

   Karlsson R., Jonsson M., Edlund K., Evander M., Gustavsson A., Bodén E., Rylander E., Wadell G. Lifetime number of partners as the only independent risk factor for human papillomavirus infection: a population-based study. Sex Transm Dis. 1995;22(2):119-127.

   Not in our library10.1097/00007435-199503000-00008

9. 9.

   Layde P. M. Smoking and cervical cancer: cause or coincidence? JAMA. 1989;261(11):1631-1633.

   Not in our library

10. 10.

    Ley C., Bauer H. M., Reingold A., Schiffman M. H., Chambers J. C., Tashiro C. J., Manos M. M. Determinants of genital human papillomavirus infection in young women. J Natl Cancer Inst. 1991;83(14):997-1003.

    Not in our library10.1093/jnci/83.14.997

11. 11.

    Melkert P. W., Hopman E., van den Brule A. J., Risse E. K., van Diest P. J., Bleker O. P., Helmerhorst T., Schipper M. E., Meijer C. J., Walboomers J. M. Prevalence of HPV in cytomorphologically normal cervical smears, as determined by the polymerase chain reaction, is age-dependent. Int J Cancer. 1993;53(6):919-923.

    Not in our library10.1002/ijc.2910530609

12. 12.

    Morrison E. A., Ho G. Y., Vermund S. H., Goldberg G. L., Kadish A. S., Kelley K. F., Burk R. D. Human papillomavirus infection and other risk factors for cervical neoplasia: a case-control study. Int J Cancer. 1991;49(1):6-13.

    Not in our library10.1002/ijc.2910490103

13. 13.

    Olsen A. O., Dillner J., Skrondal A., Magnus P. Combined effect of smoking and human papillomavirus type 16 infection in cervical carcinogenesis. Epidemiology. 1998;9(3):346-349.

    Not in our library

14. 14.

    Phillips A. N., Smith G. D. Cigarette smoking as a potential cause of cervical cancer: has confounding been controlled? Int J Epidemiol. 1994;23(1):42-49.

    Not in our library10.1093/ije/23.1.42

15. 15.

    Remmink A. J., Walboomers J. M., Helmerhorst T. J., Voorhorst F. J., Rozendaal L., Risse E. K., Meijer C. J., Kenemans P. The presence of persistent high-risk HPV genotypes in dysplastic cervical lesions is associated with progressive disease: natural history up to 36 months. Int J Cancer. 1995;61(3):306-311.

    Not in our library10.1002/ijc.2910610305

16. 16.

    Schiffman M. H. Recent progress in defining the epidemiology of human papillomavirus infection and cervical neoplasia. J Natl Cancer Inst. 1992;84(6):394-398.

    Not in our library10.1093/jnci/84.6.394

17. 17.

    Walboomers J. M., Jacobs M. V., Manos M. M., Bosch F. X., Kummer J. A., Shah K. V., Snijders P. J., Peto J., Meijer C. J., Muñoz N. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189(1):12-19.

    Not in our library10.1002/(sici)1096-9896(199909)189:1<12::aid-path431>3.0.co;2-f

18. 18.

    Wheeler C. M., Parmenter C. A., Hunt W. C., Becker T. M., Greer C. E., Hildesheim A., Manos M. M. Determinants of genital human papillomavirus infection among cytologically normal women attending the University of New Mexico student health center. Sex Transm Dis. 1993;20(5):286-289.

    Not in our library10.1097/00007435-199309000-00009

19. 19.

    Ylitalo N., Sørensen P., Josefsson A., Frisch M., Sparén P., Pontén J., Gyllensten U., Melbye M., Adami H. O. Smoking and oral contraceptives as risk factors for cervical carcinoma in situ. Int J Cancer. 1999;81(3):357-365.

    Not in our library10.1002/(sici)1097-0215(19990505)81:3<357::aid-ijc8>3.0.co;2-1

Cited by papers we hold 2

• HPV type infection in different anogenital sites among HIV-positive Brazilian women · 2008
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• Cervical HPV infection and neoplasia in a large population-based prospective study: the Manchester cohort · 2004
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