Association between war and cervical cancer among Vietnamese women

Abstract

Decades ago, cervical cancer was the leading form of cancer among women in both North Vietnam and South Vietnam. Currently, cervical cancer rates are considerably lower in the northern region of the country. We performed a case-control study to measure factors associated with the development of cervical cancer among Vietnamese women. Questionnaire-based interviews were conducted with 202 women in southern Vietnam and 97 women in northern Vietnam. Case subjects were women hospitalized with cervical cancer. Control subjects were women hospitalized with extrauterine neoplasms. Data were analyzed using logistic regression, and odds ratios for the development of invasive cervical cancer were measured. The development of invasive cervical cancer was significantly associated with military service by husbands during the Second Indochinese War and with parity status. Odds ratio for the development of cervical cancer among southern Vietnamese women whose husbands had served in the armed forces was 2.6 (95% CI ‫؍‬ 1.2-5.5). Odds ratio for the development of cervical cancer among northern women whose husbands had served in the armed forces was 3.9 (95% CI ‫؍‬ 1 Key words: cervical cancer; male factor; Second Indochinese War; VietnamCarcinoma of the uterine cervix is a public health problem of considerable significance in many developing countries. 1 Incidence rates of cervical cancer among women in Vietnam have been reported to display marked temporal and regional variation. Hospital-based tumor registries indicate that, several decades ago, cervical cancer was the most common form of cancer among women living in both northern 2 and southern 3 Vietnam. More recent population-based tumor registry studies indicate that cervical cancer is now the 4th most common form of cancer among women in northern Vietnam, with age-standardized incidence rates of 4.4 in 100,000. 4 Cervical cancer remains the most common form of cancer among women in southern Vietnam, with agestandardized incidence rates of 26 in 100,000. 5 It is generally accepted that cervical cancer is caused by persistent infection of uterine cervical epithelium by high-risk subtypes of human papillomavirus (HPV), a sexually acquired pathogen. 6 In Vietnam, regional differences in HPV prevalence correlate closely with regional differences in cervical cancer rates. 7 We undertook a questionnaire-based case control study to identify additional factors associated with the development of cervical cancer among women in Vietnam. MATERIAL AND METHODSInterviews were conducted between 1 June 1996 and 18 September 1996 at the Ho Chi Minh City Cancer Center in Ho Chi Minh City and at the National Cancer Institute in Hanoi. Women interviewed as case subjects were patients with biopsy-confirmed diagnoses of invasive cervical squamous cell carcinoma who were hospitalized at either cancer center. Case subjects were enrolled consecutively as they entered the cancer centers for treatment and included 41 northern women (40, or 98%, of whom responded to the questionnaire) and 72 southern ...

Lessons learned from successful Papanicolaou cytology cervical cancer prevention in the socialist republic of Vietnam

“…This study is limited by the axiom that not all associations are causations. The association between the Vietnam War and cervical cancer5 may have no causative meaning. The association between de novo establishment of Papanicolaou screening services in southern Vietnam2, 9 and subsequent reductions in cervical cancer incidence may also have no causative meaning.…”

“…American volunteers interested in cervical cancer prevention first visited Vietnam in January 1994,2 and were promptly presented with population‐based tumor registry data documenting cervical cancer incidence rates five times higher in southern Vietnam3 relative to northern Vietnam 4. A 1996 case‐control study sponsored by Stanford University documented that these regional variations in cervical cancer incidence rates were associated with prior troop movements during the Vietnam War 5…”

The impact of armed conflict on cancer among civilian populations in low- and middle-income countries: a systematic review

“…Three studies assessed cervical cancer incidence ( Figure 2, bottom right panel). One moderate-to-high quality case-control study of the Vietnam War showed that women with a husband in the army had higher odds of cervical cancer compared to those without (adjusted odds ratio (AOR) 1.32, 95% CI: 1.00-1.75) [42]. One low-quality ecological study in Greece assessed over 35,000 smear tests from hospitals with different proximity to the Yugoslav border, but showed no difference in either cervical cancer or cervical intraepithelial neoplasia incidence between the sites following the NATO bombing of Yugoslavia in 1999 [43].…”

The value of male human papillomavirus vaccination in preventing cervical cancer and genital warts in a low‐resource setting

“…Additionally, during the war with the USA, commercial sex outlets catering to US soldiers were common in the south . A study found that women whose husbands served in the military during the war and were stationed in south Vietnam had an increased risk of cervical cancer . More recently, urbanisation and higher disposable incomes have led to more sex outside marriage, particularly in southern Vietnam…”