A case-control study of cervix cancer in Singapore

Cuzick, Jack; Stavola, Bianca De; McCance, Dennis J.; Ho, T H; Gh, Tan; Cheng, Hui-Wen; Chew, Samuel Teong Huang; Salmon, Y M

doi:10.1038/bjc.1989.261

Cited by 30 publications

(14 citation statements)

References 35 publications

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“…Few studies from Africa have shown a similar association, though an early report from Zimbabwe did suggest a higher number of "consorts" in cervical cancer patients than controls (Frost, 1981). The results for parity (Table VII), although not significant, are in line with other reports, with an increasing risk for cervical cancer in relation to having 7 or more children (Brinton et al, 1989;Cuzick et al, 1989) and reduction in risk for breast cancer (Kalache et al, 1993;Hulka and Stark, 1995). Alcohol consumption did not appear to be a n important risk factor for liver cancer in Rwanda, but the numbers are small.…”

Section: Association Between Specific Cancers and Individual Risk Facsupporting

confidence: 88%

Cancer in Rwanda

et al. 1996

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Data are presented on the frequency of malignant tumours registered at the population-based cancer registry in the southern prefecture of Butare, Rwanda, from May 1991 until 2 months before the outbreak of civil war in April 1994. Beginning in 1992, subjects were also interviewed about socio-demographic and lifestyle factors that have been associated with cancer risk in the West. The distribution of cancer in Rwanda is similar to that in other countries in sub-Saharan Africa. The most frequent cancers are those with possible infectious aetiolo-gies: liver cancer (I 2%), cervical cancer (I 29'0) and stomach cancer (9%). In addition, cancers known to be associated with HIV infection are relatively frequent (Kaposi's sarcoma [6%] and non-Hodgkin's lymphoma [3%]). Chronic infection, including infection with HIV, high parity and multiple sexual partners are important determinants of cancer incidence in this population. Tobacco consumption is low in Rwanda and there are few tobacco-related tumours, such as lung and laryngeal cancer. Other tumours believed to be associated with aspects of Western lifestyle , such as colorectal and breast cancer, are also relatively infrequent.

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Section: Association Between Specific Cancers and Individual Risk Facsupporting

confidence: 88%

Cancer in Rwanda

et al. 1996

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“…These values were unlikely to be due to chance since the 95% confidence limits excluded unity and there were P-values of less than 0.05 for key relative risks. Similarly, other studies (25)(26)(27) reported relative risk estimates greater than one (1.2-5.7) in the longest duration of oral contraceptive use (2.5-10 years). In a recent report (28) , it was found that over a 25-year follow-up period of women using oral contraceptives, among current and recent (within 10 years) users, the relative risk of death from cervical cancer was 2.5 (1.1-6.1).…”

Section: Prospective Studiesmentioning

confidence: 65%

The role of steroid contraceptive hormones in the pathogenesis of invasive cervical cancer: A review

Moodley

Moodley²,

Chetty

et al. 2003

Int J Gynecol Cancer

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Invasive cervical cancer remains a leading cause of morbidity and mortality, especially among women in the developing world where screening is either deficient or absent. Of all agents linked to the causation of this disease, high-risk human papillomavirus (HPV) appears to be the strongest factor. However, not all women with HPV develop cervical cancer. Steroid contraception has been postulated to be one mechanism whereby HPV exerts its tumorigenic effect on cervical tissue. Steroids are thought to bind to specific DNA sequences within transcriptional regulatory regions on the HPV DNA to either increase or suppress transcription of various genes. Although some earlier studies were reassuring as no increased incidence of cervical cancer was observed, subsequent research has shown a causative association, especially among long-term users. The role of steroids was further enhanced by the discovery of hormone receptors in cervical tissue. Some earlier studies of oral contraceptive steroids found no increased risk, even after controlling for other risk factors, including smoking and number of partners. However, prospective studies have shown a greater progression of dysplasia to carcinoma-in-situ with more than 6 years of oral steroid contraceptive use. Similar findings were also evident from other work, including the Royal College of General Practitioners Oral Contraception Study. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives showed a relative risk of 1.2 for invasive cancer in users of the long-acting progestational contraceptive, depo-medroxyprogesterone acetate. However, in users of more than 5 years duration, an estimate of 2.4 was reported. The upstream regulatory region (URR) of the HPV type 16 viral genome, mediates transcriptional control of the HPV genome and is thought to contain enhancer elements that are activated by steroid hormones. It has been shown that steroid hormones bind to specific glucorticoid-response elements within HPV-DNA. Experimental evidence has revealed that high–risk type HPV 16 are able to stimulate the development of vaginal and cervical squamous cell carcinomas in transgenic mice exposed to slow-release pellets of 17 β-estradiol in the presence of human keratin-14 promoter. Squamous cell carcinomas developed in a multi-stage pathway only in transgenic mice and not in nontransgenic mice. The E6 oncoprotein of HPV 16 has been shown to bind to the p53 tumor suppressor gene and stimulate its degradation by a ubiquitin-dependent protease system. Steroid hormones are thought to increase the expression of the E6 and E7 HPV 16 oncogenes, which in turn bind to and degrade the p53 gene product, leading to apoptotic failure and carcinogenesis. However, the molecular basis of this remains to be proven.

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“…In Senegal, 24.5% of women in an infectious disease service were HPVpositive (Seck et al, 1994). Other factors may play a role also, e.g., high parity (Brinton et al, 1989;Cuzick et al, 1989;Parkin et al, 1994b).…”

Section: Discussionmentioning

confidence: 99%

Cancer incidence in Conakry, Guinea: first results from the cancer registry 1992–1995

Koulibaly¹,

Kabba²,

Cissé³

et al. 1997

Int. J. Cancer

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We have registered 2,064 cases of cancer among the inhabitants of Conakry, Guinea, during 1992-1994, corresponding to age-standardized incidence rates (ASRs) of 83.3 per 100,000 in men and 110.5 per 100,000 in women. As elsewhere in West Africa, the principal cancer of men was liver cancer (ASR 32.6), with modest rates of stomach (ASR 6.2) and prostate (ASR 8.1) cancers. In women, cervix cancer was the dominant malignancy (ASR 46.0), followed by liver cancer (ASR 12.5) and breast cancer (ASR 10.9). In contrast to contemporary East and Central Africa, Kaposi's sarcoma remained rare (only 4 cases). In the childhood age group, relatively high incidence rates were found for Hodgkin's disease, Burkitt's lymphoma and, especially, retinoblastoma.

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A case-control study of cervix cancer in Singapore

Cited by 30 publications

References 35 publications

Cancer in Rwanda

Cancer in Rwanda

The role of steroid contraceptive hormones in the pathogenesis of invasive cervical cancer: A review

Cancer incidence in Conakry, Guinea: first results from the cancer registry 1992–1995

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