> The tumor of the neck of the uterus – The risk factors

The multicenter study of the International Agency for Research on Cancer – IARC, which includes over 1500 cases of squamous cell carcinoma, less than 200 of adenocarcinoma and almost 2000 controls provides a lot of information related to risk factors for the progression from HPV infection to development of tumor lesions of the uterine cervix [1-7].

The study analyzes 10 case control studies, of which 8 related to cervical cancer invasive and two related to cervical cancer in situ.

From the meta-analysis of these studies it is concluded that 93% of adenocarcinomas and 96% of the squamous cell carcinoma are attributable to HPV infection, [1]. It seems, however, that the risk factors for the cervicocarcinoma squamous cell carcinoma may be at least partly different from those of adenocarcinoma, [1].

The risk factors for the squamous cell carcinoma, controlling for the confounding factors and to equalityà of the state of HPV infection would be prolonged use of oral contraceptives, with a risk almost 3 times when the intake of oral contraceptives is extended between 5-9 years and a risk of 4 times when is greater than or equal to 10 years (OR 2.8 95%CI 1.5, 5.4; OR 4.0 95%WE 2.1, 8.0) [2], the simultaneous infection with HSV type 2, with the risk doubled in squamous cell carcinoma and tripled for adenocarcinoma (OR 2.2 95% CI 1.4, 3.4; OR 3.4 95%CI 1.5, 7.7) [3], a number of children equal to or greater than 7, that multiplies by 4 times the risk of having a squamous cell carcinoma (OR 3.8 95%CI 2.7, 5.5), but has no effect on adenocarcinoma [4], the habit of cigarette smoking with the risk doubled for women (OR 2.3 95%CI 1.3, 4.0); the risk is however significantly altered in former smokers, [5].

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unlike the male circumcision is a protective factor, reducing not only the risk of HPV infection at the level of the penis (OR 0.37 95%CI 0.16, 0.85), but also the risk of infecting the woman (you halve the risk, even when the man has multiple sexual partners, OR 0.42 95%CI 0.23, 0.79) [6].

Some of the identified risk factors for adenocarcinoma, on whose interpretation you have toò to be cautious, in view of the esiguità of the cases analyzed (167 women with adenocarcinoma), would instead of illiteracy (women with no scolarità have a risk tripled compared with women with more than 10 years of schooling), the poor hygiene (increases of 6 times the risk in women who do shower or bathe less than once a day), the long-term use of oral contraceptives (increases by 5 times the risk if equal to or greater than 5 years), the early beginning of the activitiesà sexual (triples the risk in women with less than 18 years compared to women of 23 or più years).

Interesting the relief that the use of the IUD (spiral) seems to have a protective effect with an OR 0.41 (0.18, 0.93) [7].

This is known in the case of tumors of the body of the uterus but not the cervix: the authors admit that this could also be a selection bias, as the patients with IUD may more frequently undergo Pap tests, even if in the analysis this factor is controlled.

Bibliography

1. Castellsague X, Diaz M, de Sanjose S, Munoz N, Herrero R, Franceschi S, Peeling RW, Ashley R, Smith JS, Snijders PJ, Meijer CJ, Bosch FX; International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Worldwide human papillomavirus etiology of cervical adenocarcinoma and its cofactors: implications for screening and prevention. J Natl Cancer Inst. 2006;98:303-15 [Medline]

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2. Moreno V, Bosch FX, Munoz N, Meijer CJ, Shah KV, Walboomers JM, Herrero R, Franceschi S; International Agency for Research on Cancer. Multicentric Cervical Cancer Study Group. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet. 2002;359:1085-92 [Medline]

3. Smith JS, Herrero R, Bosetti C, Munoz N, Bosch FX, Eluf-Neto J, Castellsague X, Meijer CJ, Van den Brule AJ, Franceschi S, Ashley R; International Agency for Research on Cancer (IARC) Multicentric Cervical Cancer Study Group. Herpes simplex virus-2 as a human papillomavirus cofactor in the etiology of invasive cervical cancer. J Natl Cancer Inst. 2002;94:1604-13 [Medline]

4. Munoz N, Franceschi S, Bosetti C, Moreno V, Herrero R, Smith JS, Shah KV, Meijer CJ, Bosch FX; International Agency for Research on Cancer. Multicentric Cervical Cancer Study Group. Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet. 2002;359:1093-101 [Medline]

5. Plummer M, Herrero R, Franceschi S, Meijer CJ, Snijders P, Bosch FX, de Sanjose S, Munoz N; IARC Multi-centre Cervical Cancer Study Group. Smoking and cervical cancer: pooled analysis of the IARC multi-centric case-control study. Cancer Causes Control. 2003;14:805-14 [Medline]

6. Castellsague X, Bosch FX, Munoz N, Meijer CJ, Shah KV, de Sanjose S, Eluf-Neto J, Ngelangel CA, Chichareon S, Smith JS, Herrero R, Moreno V, Franceschi S; International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med. 2002;346:1105-12 [Medline]

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7. Castellsague X, Diaz M, de Sanjose S, Munoz N, Herrero R, Franceschi S, Peeling RW, Ashley R, Smith JS, Snijders PJ, Meijer CJ, Bosch FX; International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Worldwide human papillomavirus etiology of cervical adenocarcinoma and its cofactors: implications for screening and prevention. J Natl Cancer Inst. 2006;98:303-15 [Medline]

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Page updated on April 1, 2007