Cancer Causes & Control

, Volume 13, Issue 7, pp 683–690 | Cite as

Risk factors for progression of squamous cell cervical carcinoma in-situ to invasive cervical cancer: results of a multinational study

  • David B. Thomas
  • Roberta M. Ray
  • Qin Qin

Abstract

Objective: Human papillomaviruses (HPVs) are probably necessary causes of cervical carcinoma, but few infected women develop invasive cervical cancer, suggesting a role for cofactors. The purpose of this study was to identify cofactors associated with progression of carcinoma in-situ to invasion. Methods: Data from in-person interviews of women included in a multinational, hospital-based case–control study of in-situ and invasive squamous cell cervical carcinoma were analyzed. In-situ cases and controls were compared to identify risk factors for carcinoma in-situ, and invasive and in-situ cases were compared to identify risk factors for progression to invasive disease. Results: Risk of invasion was decreased in women with a history of cytologic screening, and in relation to other variables that likely represent enhanced opportunities for screening or clinical evaluation of symptomatic disease. No other risk or protective factors for progression were convincingly demonstrated. Risk of progression was not associated with multiple incidences of promiscuous sexual behavior, or use of steroid contraceptives, although there was a possible association with high parity. Conclusions: Possible cofactors that have been considered in this study alter the carcinogenicity of an HPV infection primarily prior to the development of cervical carcinoma in-situ. Women with a history of this condition need not avoid use of steroid contraceptives.

carcinoma cervical intraepithelial neoplasia cervix neoplasms squamous cell 

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References

  1. 1.
    International Agency for Research on Cancer (1995) Human Papillomaviruses. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol. 64. Lyon: International Agency for Research on Cancer, pp. 87–231.Google Scholar
  2. 2.
    Moreno V, Munoz N, Bosch FX, et al. (1995) Risk factors for progression of cervical intraepithelial neoplasm grade III to invasive cervical cancer. Cancer Epidemiol Biomarkers Prev 4: 459–467.Google Scholar
  3. 3.
    Thomas DB, Qin Q, Kuypers J, et al. (2001) Human papillomaviruses and cervical cancer in Bangkok. II. Risk factors for in-situ and invasive squamous cell cervical carcinomas. Am J Epidemiol 153: 732–739.Google Scholar
  4. 4.
    WHO Collaborative Study of Neoplasia and Steroid Contraceptives (1993) Invasive squamous-cell cervical carcinoma and combined oral contraceptives: results from a multinational study. Int J Cancer 55: 228–236.Google Scholar
  5. 5.
    Ye Z, Thomas DB, Ray RM, and the WHO Collaborative Study of Neoplasia and Steroid Contraceptives (1995) Combined oral contraceptives and risk of cervical carcinoma in-situ. Int J Epidemiol 24: 19–26.Google Scholar
  6. 6.
    Poulsen HE, Taylor CW, Sobin LH (1975) Histological Typing of Female Genital-tract Tumours. Geneva: World Health Organization, pp. 55–59.Google Scholar
  7. 7.
    Breslow NE, Day NE (1980) Statistical Methods in Cancer Research. vol. I: The Analysis of Case-Control Studies. IARC Sci. Publ. No. 32, Lyon: International Agency for Research on Cancer, pp. 5–338.Google Scholar
  8. 8.
    Begg CB, Zhang ZF (1994) Statistical analysis of molecular epidemiology studies employing case-control series. Cancer Epidemiol Biomarkers Prev 3: 173–175.Google Scholar
  9. 9.
    Ngelangel C, Munoz N, Bosch FX, et al. (1998) Causes of cervical cancer in the Philippines: a case-control study. J Natl Cancer Inst 90: 43–49.Google Scholar
  10. 10.
    Chaouki N, Bosch FX, Munoz N, et al. (1998) The viral origin of cervical cancer in Rabat, Morocco. Int J Cancer 75: 546–554.Google Scholar
  11. 11.
    International Agency for Research on Cancer (1999) Hormonal Contraception and Post-menopausal Hormone Therapy. Lyon: International Agency for Research on Cancer, pp. 127–156.Google Scholar
  12. 12.
    Bosch FX, Manos MM, Munoz N, et al. (1995) Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst 87: 796–802.Google Scholar
  13. 13.
    Thomas DB, Ray RM, Koetsawang A, et al. (2001) Human papillomaviruses and cervical cancer in Bangkok. I. Risk factors for invasive cervical carcinomas with human papillomavirus types 16 and 18 DNA. Am J Epidemiol 153: 723–731.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • David B. Thomas
    • 1
  • Roberta M. Ray
    • 1
  • Qin Qin
    • 1
  1. 1.Program in EpidemiologyFred Hutchinson Cancer Research CenterSeattleUSA

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