Risk factors for adenocarcinoma and squamous cell carcinoma of the cervix in women aged 20–44 years: the UK National Case–Control Study of Cervical Cancer

Abstract

We report results on risk factors for invasive squamous cell and adenocarcinomas of the cervix in women aged 20 -44 years from the UK National Case -Control Study of Cervical Cancer, including 180 women with adenocarcinoma, 391 women with squamous cell carcinoma and 923 population controls. The risk of both squamous cell and adenocarcinoma was strongly related to the lifetime number of sexual partners, and, independently, to age at first intercourse. The risk of both types of cervical cancer increased with increasing duration of use of oral contraceptives, and this effect was most marked in current and recent users of oral contraceptives. The risk of squamous cell carcinoma was associated with high parity and the risk of both squamous cell and adenocarcinoma increased with early age at first birth. Long duration smoking (20 or more years) was associated with a two-fold increase in the risk of squamous cell carcinoma, but smoking was not associated with the risk of adenocarcinoma. Further studies are needed to confirm the suggestion from this and other studies of differences in risk related to smoking between squamous cell and adenocarcinomas of the cervix. Among cancers of the uterine cervix, adenocarcinomas are much less common than squamous cell carcinomas. As for squamous cell carcinoma, human papillomavirus (HPV) infection appears to be a major risk factor for adenocarcinoma of the cervix (Kjaer and Brinton, 1993;Walboomers et al, 1999;Santos et al, 2001;Altekruse et al, 2003), but evidence on other factors that may affect the risk of adenocarcinoma is limited and not entirely consistent (Parazzini and La Vecchia, 1990;Kjaer and Brinton, 1993;Ursin et al, 1994Ursin et al, , 1996Lacey et al, 1999Lacey et al, , 2000Lacey et al, , 2001Madeleine et al, 2001;Altekruse et al, 2003). The question of whether there are substantial differences in the risk factors for adenocarcinomas and squamous cell carcinomas remains unresolved. Few epidemiological studies have been designed specifically to provide a direct comparison between adenocarcinoma and squamous cell carcinoma of the cervix, and most studies of cervical carcinoma have had too few cases of adenocarcinoma to allow full evaluation of the possible risk factors. We present here results from the UK National Case -Control Study of Cervical Cancer, a case -control study of risk factors for invasive cervical cancer in women under 45 years old at diagnosis, with 180 cases of adenocarcinoma (including adenosquamous carcinoma), 391 cases of squamous cell carcinoma and 923 population controls. Information was available for all study subjects on sexual and reproductive factors, cervical screening, body weight, smoking and the use of barrier and hormonal contraceptives. Additional information was collected on HPV serology for a subgroup of subjects, and for this subgroup results have previously been published on the relationship between HPV positivity and risk of cervical cancer (Jha et al, 1993), and on oral contraceptive use as a risk factor for cervical cancer in relati...

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

“…In contrast, results of studies in more developed countries where there is a longer latency period between sexual initiation and AFP, as in Spain, the US (Brinton et al, 1987) or Italy (Parazzini et al, 1989) tend to show an increased risk with early AFSI but not with AFP as first pregnancies tend to occur much later. It is interesting that, in countries like the UK, where the rates of teenage pregnancies are high, women with AFSI of p17 years had a 2 -3-fold increased risk for cervical cancer compared with those with AFSI X20 years (Green et al, 2003). Consistently, women with an early AFP of 15 -19 years had a two-fold increased risk for cervical cancer compared with those with AFP X25 years (Green et al, 2003).…”

“…It is interesting that, in countries like the UK, where the rates of teenage pregnancies are high, women with AFSI of p17 years had a 2 -3-fold increased risk for cervical cancer compared with those with AFSI X20 years (Green et al, 2003). Consistently, women with an early AFP of 15 -19 years had a two-fold increased risk for cervical cancer compared with those with AFP X25 years (Green et al, 2003). These observations merit further exploration but, in aggregate, tend to indicate a significant increase in risk of neoplastic disease when early AFSI occurs (surrogate of early HPV exposure and a period of increased cervical susceptibility) and is followed closely by an early pregnancy (surrogate of early exposure to high oestrogen levels).…”

Therapeutic Effectiveness of Large Loop Excision of Transformation Zone (LLETZ) in Management of Cervical Lesions

“…This correlated with study conducted by Sapkal RU (2002) in which highest percentage of CIN lesions were seen in patients whose age at first coitus was less than 18 years. [5] According to Green et al (2003), risk of cervical cancer increased with early age at first intercourse. [7] As shown in figure 1, maximum number of patients 60% presented with leucorrhoea, 22% with postcoital bleeding, 12% with intermenstrual bleeding and 6% with postmenopausal bleeding.…”

“…[5] According to Green et al (2003), risk of cervical cancer increased with early age at first intercourse. [7] As shown in figure 1, maximum number of patients 60% presented with leucorrhoea, 22% with postcoital bleeding, 12% with intermenstrual bleeding and 6% with postmenopausal bleeding. This correlates with study done by Pathare et al in which LEEP was performed as an outdoor procedure in patient with above similar complaints.…”

Efficacy and side‐effects of oral contraceptives

“…26 COCs appear to be only a weak co-factor with smoking, and the presence of certain types of the human papilloma virus (HPV) is more important. 27 Women using COCs should be counselled against smoking, to use condoms to protect against sexually transmitted infections and to avail themselves of the cervical screening programme.…”