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Association of Combined Tobacco Smoking, Hormonal Contraceptive use and Status Matrimonial with Cervical Cancer Evolution in Tunisian Women

  • Original Article
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Pathology & Oncology Research

Abstract

Status matrimonial, cigarette smoking and hormonal contraceptive (HC) use have been associated with cervical cancer (CC) establishment by influencing the CC carcinogenesis process. In the present study, we aim to confirm this correlation between these factors and the risk of CC occurrence among Tunisian population. To evaluate the role of matrimonial status, smoking and HC as cofactors of CC installation, we performed a random selection of 600 women from Salah Azeiz institute in Tunisia and a questionnaire was conducted by doctors for each patient. Logistic regression after adjustment for potential confounding factors, relative excess risk due to interaction (RERI) and synergy index (S) were used to evaluate the additive interaction. Subgroup analysis was conducted to examine whether the relative risks changed with CC stages. There were an excess risk among smoker patients and patient with HC use (p < 0.001) for CC installation. Women who are smokers have a 14 times greater risk of suffering from cervical cancer and approximately 24 times greater to develop an advanced form of CC malignancy. Having a history of using birth control pills increase CC occurrence and aggravation (OR~2). The matrimonial status seems an important factor for CC appearance (OR = 3.58 and 2.46) among CC Tunisian patient. However, no significant biological interaction from this three joint exposure was observed in the early FIGO stages but the risk increase in advanced FIGO stages. In our Tunisian cohort, oral contraception, smoking habit and matrimonial status are associated with an overall increased risk of CC development. Indeed, it may damage the local immunity system and may affect the disease severity in patient carriers of some genetic risk biomarkers. The balance of cancer risks may vary among Tunisian CC patient, depending on some environmental co-factors.

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References

  1. Harper DM, Demars LR (2014) Primary strategies for HPV infection and cervical cancer prevention. Clin Obstet Gynecol 57:256–258

    Article  Google Scholar 

  2. IARC (2003) Monographs. International Agency for Research on Cancer, Lyon

    Google Scholar 

  3. Castle PE, Wacholder S, Lorincz AT, Scott DR, Sherman ME, Glass AG et al (2002) A prospective study of high-grade cervical neoplasia risk among human papillomavirus-infected women. J Natl Cancer Inst 94:1406–1414

    Article  Google Scholar 

  4. Longatto-Filho A, Hammes LS, Sarian LO, Roteli-Martins C, Derchain SF, Eržen M et al (2011) Hormonal contraceptives and the length of their use are not independent risk factors for high-risk HPV infections or high-grade CIN. Gynecol Obstet Investig 71:93–103

    Article  CAS  Google Scholar 

  5. Harris TG, Miller L, Kulasingam SL, Feng Q, Kiviat NB, Schwartz SM et al (2009) Depot-medroxyprogesterone acetate and combined oral contraceptive use and cervical neoplasia among women with oncogenic human papillomavirus infection. Am J Obstet Gynecol 200:489.e1–489.e8

    Article  Google Scholar 

  6. Frega A, Scardamaglia P, Piazze J, Cerekja A, Pacchiarotti A, Verrico M et al (2008) Oral contraceptives and clinical recurrence of human papillomavirus lesions and cervical intraepithelial neoplasia following treatment. Int J Gynaecol Obstet 100:175–178

    Article  CAS  Google Scholar 

  7. Syrjänen K, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J et al (2006) Oral contraceptives are not an independent risk factor for cervical intraepithelial neoplasia or high-risk human papillomavirus infections. Anticancer Res 26:4729–4740

    PubMed  Google Scholar 

  8. Gadducci A, Barsotti C, Cosio S, Domenici L, Riccardo Genazzani A (2011) Smoking habit, immune suppression, oral contraceptive use, and hormone replacement therapy use and cervical carcinogenesis: a review of the literature. Gynecol Endocrinol 27:597–604

    Article  Google Scholar 

  9. La Vecchia C, Boccia S. Oral contraceptives, human papillomavirus and cervical cancer. Eur J Cancer Prev 2014; 23:110–112

  10. Poppe WA, Ide PS, Drijkoningen MP, Lauweryns JM, Van Assche FA (1995) Tobacco smoking impairs the local immunosurveillance in the uterine cervix. An immunohistochemical study. Gynecol Obstet Investig 39:34–38

    Article  CAS  Google Scholar 

  11. Poppe WA, Peeters R, Drijkoningen M, Ide PS, Daenens P, Lauweryns JM et al (1996) Cervical cotinine and macrophage- Langerhans cell density in the normal human uterine cervix. Gynecol Obstet Investig 41:253–259

    Article  CAS  Google Scholar 

  12. Oh HY, Kim MK, Seo S-S, Lee J-K (2016) Association of Combined Tobacco Smoking and Oral Contraceptive use with Cervical Intraepithelial Neoplasia 2 or 3 in Korean Women. J Epidemiol 26(1):22–29

    Article  Google Scholar 

  13. Zidi1 S, Sghaier1 I, Gazouani E, Mezlini A, Yacoubi-Loueslati B (2015) Evaluation of Toll-Like Receptors 2/3/4/9 Gene Polymorphisms in Cervical Cancer Evolution. Pathol. Oncol. Res. https://doi.org/10.1007/s12253-015-0009-6

  14. Pandey S, Mittal B, Srivastava M, Singh S, Srivastava K, Lal P, Mittal RD (2011) Evaluation of toll-like receptors 3 (c 1377C/T) and 9 (G2848A) gene polymorphisms in cervical cancer susceptibility. Mol Biol Rep 38:4715–4721

    Article  CAS  Google Scholar 

  15. Kim J, Kim BK, Lee CH, Seo SS, Park SY, Roh JW (2012) Human papillomavirus genotypes and cofactors causing cervical intraepithelial neoplasia and cervical cancer in Korean women. Int J Gynecol Cancer 22:1570–1576

    PubMed  Google Scholar 

  16. Kim JW, Song SH, Jin CH, Lee JK, Lee NW, Lee KW (2012) Factors affecting the clearance of high-risk human papillomavirus infection and the progression of cervical intraepithelial neoplasia. J Int Med Res 40:486–496

    Article  CAS  Google Scholar 

  17. Tay SK, Tay KJ (2004) Passive cigarette smoking is a risk factor in cervical neoplasia. Gynecol Oncol 93:116–120

    Article  Google Scholar 

  18. Tsai HT, Tsai YM, Yang SF, Wu KY, Chuang HY, Wu TN et al (2007) Lifetime cigarette smoke and second-hand smoke and cervical intraepithelial neoplasm—a community-based case-control study. Gynecol Oncol 105:181–188

    Article  CAS  Google Scholar 

  19. Natphopsuk S, Settheetham-Ishida W, Sinawat S, Pientong C, Yuenyao P, Ishida T (2012) Risk factors for cervical cancer in northeastern Thailand: detailed analyses of sexual and smoking behavior. Asian Pac J Cancer Prev 13:5489–5495

    Article  Google Scholar 

  20. Alam S, Conway MJ, Chen HS, Meyers C (2008) The cigarette smoke carcinogen benzo[a]pyrene enhances human papillomavirus synthesis. J Virol 82:1053–1058

    Article  CAS  Google Scholar 

  21. Stämpfli MR, Anderson GP (2009) How cigarette smoke skews immune responses to promote infection, lung disease and cancer. Nat Rev Immunol 9:377–384

    Article  Google Scholar 

  22. Sundberg K, Johansson AS, Stenberg G, Widersten M, Seidel A, Mannervik B et al (1998) Differences in the catalytic efficiencies of allelic variants of glutathione transferase P1-1 towards carcinogenic diol epoxides of polycyclic aromatic hydrocarbons. Carcinogenesis 19:433–436

    Article  CAS  Google Scholar 

  23. Jee SH, Lee JE, Kim S, Kim JH, Um SJ, Lee SJ et al (2002) GSTP1 polymorphism, cigarette smoking and cervical cancer risk in Korean women. Yonsei Med J 43:712–716

    Article  CAS  Google Scholar 

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Acknowledgements

We thank all women who participated in the present study. We are grateful to the staff of Salah Azeiz institute for their collection.

Funding

The study was partially supported by the Tunisian Ministry of Higher Education, Scientific Research and Information and Communication Technologies.

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Authors and Affiliations

  1. Faculty of Sciences of Tunis, Laboratory of Mycology, Pathology and Biomarkers Tunis, El Manar University, 2092, Tunis, Tunisia

    Sabrina Zidi & Besma Yacoubli-Loueslati

  2. Charles Nicolle Hospital, Tunis, Tunisia

    Mariem Sahli

  3. Salah Azeiz Oncology Institute, Tunis, Tunisia

    Amel Mezlini

Authors
  1. Sabrina Zidi
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  2. Mariem Sahli
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  3. Amel Mezlini
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  4. Besma Yacoubli-Loueslati
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Corresponding author

Correspondence to Sabrina Zidi.

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The study protocol was approved by the Ethics Committee at Salah Azeiz Oncology Institute in Tunis, Tunisia.

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All authors are in agreement to publish this paper.

Competing interests

The authors declare that they have no conflicts of interest concerning this article.

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Zidi, S., Sahli, M., Mezlini, A. et al. Association of Combined Tobacco Smoking, Hormonal Contraceptive use and Status Matrimonial with Cervical Cancer Evolution in Tunisian Women. Pathol. Oncol. Res. 26, 217–222 (2020). https://doi.org/10.1007/s12253-018-0442-4

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  • DOI: https://doi.org/10.1007/s12253-018-0442-4

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