Smoking as a major risk factor for cervical cancer and pre-cancer: Results from the EPIC cohort

Abstract

A total of 308,036 women were selected from the European Prospective Investigation into Cancer and Nutrition (EPIC) study to evaluate the association between tobacco smoking and the risk of cervical intraepithelial neoplasia of grade 3 (CIN3)/carcinoma in situ (CIS) and invasive cervical cancer (ICC). At baseline, participants completed a questionnaire and provided blood samples. During a mean follow‐up time of 9 years, 261 ICC cases and 804 CIN3/CIS cases were reported. In a nested case–control study, the baseline sera from 609 cases and 1,218 matched controls were tested for L1 antibodies against HPV types 11, 16, 18, 31, 33, 35, 45, 52, 58, and antibodies against Chlamydia trachomatis (CT), and Human Herpes Virus 2 (HHV‐2). Cervical samples were not available for HPV‐DNA analysis in this study. Multivariate analyses were used to estimate associations between smoking and risk of CIN3/CIS and ICC in the cohort and the case–control studies. In the cohort analyses smoking status, duration and intensity showed a two‐fold increased risk of CIN3/CIS and ICC, while time since quitting was associated with a two‐fold reduced risk. In the nested case–control study, consistent associations were observed after adjustment for HPV, CT and HHV‐2 serostatus, in both HPV seronegative and seropositive women. Results from this large prospective study confirm the role of tobacco smoking as an important risk factor for both CIN3/CIS and ICC, even after taking into account HPV exposure as determined by HPV serology. The strong beneficial effect of quitting smoking is an important finding that will further support public health policies for smoking cessation.

Incidence, mortality and risk factors of cervical cancer in the world

“…In a large cohort study, the risk of cancer was reduced by 50% among those who stopped smoking for 10 years when compared with those who continued to smoke. In this study, passive smoking was not associated with an increased risk of cervical cancer (Roura et al, 2014). Rather, the age of smoking is related to the incidence of cervical cancer.…”

“…Several epidemiological studies have revealed the role of various genetic factors in the incidence of cervical cancer (La Vecchia and Boccia, 2014;Roura et al, 2014;Silva et al, 2014). Among them are the infection of patients with one of the human papilloma virus (HPV) oncogene types; this factor is the most important etiological factor for induction of this cancer Plummer et al, 2016).…”

MMP-9/RECK Imbalance: A Mechanism Associated with High-Grade Cervical Lesions and Genital Infection by Human Papillomavirus and Chlamydia trachomatis

“…In addition to genital infections, behavior and physiologic characteristics such as smoking, parity, oral contraceptives, alcohol, and age at first sexual intercourse have been described as factors that influence acquisition of HPV and development of neoplastic lesion (35)(36)(37)(38). In this context, we found a higher frequency of smoking patients in the study group when compared with the control group.…”

“…In this context, we found a higher frequency of smoking patients in the study group when compared with the control group. In fact, a large longitudinal study have reported smoking as a risk factor for CIN3 and invasive cervical carcinoma (38). The induction of epigenetic changes could explain this finding, as it has been shown that smoking increases the risk of methylation of the tumor-suppressor gene CDKN2A (p16), an epigenetic inactivation strongly associated with the pathogenesis of malignancies (39).…”

The Prospects of Application Medical Decision-Making Support System in Step of After-Screening Measures for Cervical Diseases in the Russian Federation on an Example of the Rostov Region

“…Не-гативными также являются данные о том, что зна-чительное число женщин курит при наличии фоно-вой цервикальной патологии, не зная, что это один из основных факторов риска развития предрака шейки матки [9].…”