Factors That Influence the Rate of Epithelial Maturation in the Cervix in Healthy Young Women

Abstract

Purpose To examine the longitudinal changes in the epithelial topography of the cervix in healthy young women; and to determine the sociodemographic, behavioral, and biological factors associated with the rate of cervical epithelial maturation. Methods Healthy young women were enrolled (10/00-9/02) as part of a larger study of human papillomavirus (HPV). At interval visits, interviews, infection testing, and colpophotography (3% acetic acid; 10X,16X magnifications) were performed. Areas of total cervical face and cervical immaturity, defined as columnar and early squamous metaplasia, were quantitatively measured using computerized planimetry. Cervical immaturity was expressed as percentage of total cervical face. This analysis includes the first consecutive 145 women with greater than 10% immaturity at baseline. The rate of cervical maturation was defined as change in percent-immaturity. Predictors included sociodemographics, sexual behaviors, and infections. Data analyses included multivariate generalized linear models with repeated measures. Results The baseline mean age was 17.8 years. Colpophotographs were available from 815 total visits, representing 2.7 years mean follow-up per woman and 5.9 month mean intervals. Women began the study with a median of 39% immaturity and ended with 8% immaturity. After adjusting for time and baseline percent-immaturity, an increased rate of cervical maturation was associated with oral contraceptive pill use (parameter estimate −0.023, p=0.04) and smoking (−0.039, p=0.01). Conclusions Cervical maturation was documented during relatively short time periods for the vast majority of these women. Oral contraceptive pills and smoking may accelerate the maturational process, representing increased cell proliferation and thus a possible greater vulnerability to HPV.

Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries

“…During adolescence and pregnancy, the cervix is exposed to augmented levels of hormonal changes (Singer and Monaghan, 2000), in which oestrogen stimulation facilitates acidification of the vaginal cavity, a determinant of squamous metaplasia when the endocervical epithelial everts (Elson et al, 2000). When this oestrogen-stimulated metaplastic transformation occurs in the presence of HPV, the probability of cell transformation increases, resulting in neoplastic changes (Elson et al, 2000;Shai et al, 2007Shai et al, , 2008Hwang et al, 2009). This phenomenon is dependent primarily on parity, and is more likely to occur during the first pregnancy rather than subsequent pregnancies (Singer and Monaghan, 2000).…”

Endogenous Sex Steroids and Risk of Cervical Carcinoma: Results from the EPIC Study

“…1). However, sex steroid hormones are essential for the differentiation and maturation of the human cervix and its vulnerability to HPV infection (2). The cervical epithelium remains relatively quiescent until the surge of estrogens and progesterone at puberty when the basal cells of the originally thin columnar epithelium transform into squamous cells in a physiologic process termed squamous metaplasia.…”

Risk Factors for Cervical Cancer in Rural Areas of Wuhan China: a Matched Case-control Study

“…During pregnancy, the cervix is exposed to augmented levels of hormonal changes, in which oestrogen stimulation facilitates acidification of the vaginal cavity, a determinant of squamous metaplasia when the endocervical epithelial everts (Elson et al, 2000). When this oestrogen-stimulated metaplastic transformation occurs in the presence of HPV, the probability of cell transformation increases, resulting in neoplastic changes (Elson et al, 2000;Hwang et al, 2009). This phenomenon is dependent primarily on parity, and is more likely to occur during the first pregnancy rather than subsequent pregnancies (Louie et al, 2009).…”