International Journal of Epidemiology 2000;29:817-825
© International Epidemiological Association 2000
Co-factors related to the causal relationship between human papillomavirus and invasive cervical cancer in Honduras
a Department of Microbiology, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras.
b Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
c Department of Oncology and Gynecology, Hospital General San Felipe, Tegucigalpa, Honduras.
d Department of Pathology, Instituto Nacional del Tórax, Tegucigalpa, Honduras.
e Department of Medical Microbiology, University of Nijmegen, The Netherlands.
Reprint requests to: Annabelle Ferrera, PO Box 30078, Tegucigalpa, Honduras. E-mail: anabelle{at}gbm.hn
Background A case-control study was conducted in Honduras to identify co-factors in the carcinogenic pathway by which human papillomavirus (HPV) causes invasive cervical cancer.
Methods Ninety-nine cases aged 23–65 (median 47) years participated. Two controls were matched to each case by age and clinic where they first presented for cytological screening; controls had no cervical abnormalities. Information on risk factors was obtained by personal interviews in the clinics regarding sociodemographic, reproductive and behavourial characteristics. Human papillomavirus was detected in cervical scrapes by general primer-mediated polymerase chain reaction (PCR) followed by sequence analysis to identify the different types present.
Results All cases had squamous cell tumours and most were FIGO (International Federation of Gynecologists and Obstetricians) class II or higher; HPV was strongly associated with cervical cancer (odds ratio [OR] = 7.66, 95% CI : 3.88–15.1). Among HPV-positive women, dose-response relationships were observed for education, age at first intercourse and exposure to wood smoke that persisted after adjustment for previous screening. Among HPV-negative women, the number of sexual partners and parity were associated with cervical cancer. The protective effect of previous cytological screening operated independently of HPV.
Conclusions Our findings speak for the powerful role that both primary and secondary education plays in fostering a lifestyle that reduces the risk of invasive cervical cancer. The data suggest that important elements of such a lifestyle include later age at first sexual intercourse, a limited number of pregnancies, greater likelihood of undergoing cytological screening and reduced exposure to carcinogens in the household environment.
Keywords Human papillomavirus, cervical cancer, risk factors
Accepted 24 March 2000
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