Is Smoking an Independent Risk Factor for Invasive Cervical Cancer? A Nested Case-Control Study Within Nordic Biobanks

• Published in: American journal of epidemiology Vol. 169; no. 4; pp. 480 - 488
• Main Authors: Kapeu, Aline Simen, Luostarinen, Tapio, Jellum, Egil, Dillner, Joakim, Hakama, Matti, Koskela, Pentti, Lenner, Per, Löve, Arthur, Mahlamaki, Eija, Thoresen, Steinar, Tryggvadóttir, Laufey, Wadell, Göran, Youngman, Linda, Lehtinen, Matti
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 15-02-2009; Oxford Publishing Limited (England)
• Subjects: Adenocarcinoma - blood; Adenocarcinoma - epidemiology; Adenocarcinoma - etiology; Adult; Aged; Analysis. Health state; Biological and medical sciences; Biomarkers - blood; Carcinoma; Case-Control Studies; Chlamydia trachomatis; Chlamydia trachomatis - immunology; Confounding Factors (Epidemiology); Correlation analysis; Cotinine - blood; Epidemiology; Europe - epidemiology; Female; Female genital diseases; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; General aspects; Gynecology. Andrology. Obstetrics; Health Sciences; Herpesvirus 2, Human - immunology; Human papillomavirus; Human papillomavirus 16; Human papillomavirus 16 - immunology; Human papillomavirus 18 - immunology; Humans; Hälsovetenskap; Immunoglobulin G - blood; Logistic Models; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Miscellaneous; neoplasms; Neoplasms, Squamous Cell - blood; Neoplasms, Squamous Cell - epidemiology; Neoplasms, Squamous Cell - etiology; Oncogenes; Pregnancy; Public Health, Global Health, Social Medicine and Epidemiology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Registries; Risk Factors; Smoking; Smoking - adverse effects; Smoking - blood; Smoking - epidemiology; squamous cell; Tobacco, tobacco smoking; Toxicology; Tumor Virus Infections - complications; Tumors; uterine cervical; uterine cervical neoplasms; Uterine Cervical Neoplasms - blood; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - etiology; Europe; risk factors; carcinoma, squamous cell; uterine cervical neoplasms; smoking; Human; Carcinoma; Independence; Tobacco smoking; Case control study; Malignant tumor; Epidemiology; Female genital diseases; squamous cell; risk factors; smoking; uterine cervical neoplasms; Tobacco; Uterus; Statistical model; Female genital system; Risk factor; Cell; Uterine cervix diseases; Cervical cancer; Public health; Cancer
• ISSN: 0002-9262; 1476-6256; 1476-6256
• DOI: 10.1093/aje/kwn354

The strong correlation between smoking and exposure to oncogenic human papillomaviruses (HPVs) has made it difficult to verify the independent role of smoking in cervical carcinogenesis. Thus, the authors evaluated this role. Five large Nordic serum banks containing samples from more than 1,000,000 subjects were linked with nationwide cancer registries (1973–2003). Serum samples were retrieved from 588 women who developed invasive cervical cancer and 2,861 matched controls. The samples were analyzed for cotinine (a biomarker of tobacco exposure) and antibodies to HPV types 16 and 18, herpes simplex virus type 2, and Chlamydia trachomatis. Smoking was associated with the risk of squamous cell carcinoma (SCC) among HPV16- and/or HPV18-seropositive heavy smokers (odds ratio = 2.7, 95% confidence interval: 1.7, 4.3). A similar risk of SCC (odds ratio = 3.2, 95% confidence interval: 2.6, 4.0) was found in heavy smokers after adjustment for HPV16/18 antibodies. The point estimates increased with increasing age at diagnosis and increasing cotinine level. This study confirms that smoking is an independent risk factor for cervical cancer/SCC in women infected with oncogenic HPVs. These findings emphasize the importance of cervical cancer prevention among women exposed to tobacco smoke.