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

Roura, Esther; Castellsague, Xavier; Pawlita, Michael; Travier, Noemie; Waterboer, Tim; Margall, Nuria; Xavier Bosch, F.; de Sanjose, Silvia; Dillner, Joakim and Gram, Inger T., et al. (2014) In International Journal of Cancer 135(2). p.453-466
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... (More)
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. What's new? Tobacco smoking is a cited cause of cervical cancer, but whether it causes cervical malignancy independent of human papillomavirus (HPV) infection is unclear. Here, strong associations were found between most measures of tobacco smoking and the risk of cervical intraepithelial neoplasia of grade 3/carcinoma in situ and invasive cervical cancer, after taking into account past exposure to HPV infection. Quitting smoking was associated with a 2-fold risk reduction. The findings confirm the role of tobacco smoking in cervical carcinogenesis and show that quitting the habit has important benefits for cancer protection. (Less)
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keywords
cohort study, cervical cancer, smoking, Human Papillomavirus serology, EPIC
in
International Journal of Cancer
volume
135
issue
2
pages
453 - 466
publisher
John Wiley & Sons
external identifiers
  • wos:000335460400023
  • scopus:84900037223
ISSN
0020-7136
DOI
10.1002/ijc.28666
language
English
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yes
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5ebb51dc-580a-4f97-8f8b-00cc93c13c02 (old id 4558762)
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2014-08-01 07:40:31
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2017-11-12 03:02:31
@article{5ebb51dc-580a-4f97-8f8b-00cc93c13c02,
  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. What's new? Tobacco smoking is a cited cause of cervical cancer, but whether it causes cervical malignancy independent of human papillomavirus (HPV) infection is unclear. Here, strong associations were found between most measures of tobacco smoking and the risk of cervical intraepithelial neoplasia of grade 3/carcinoma in situ and invasive cervical cancer, after taking into account past exposure to HPV infection. Quitting smoking was associated with a 2-fold risk reduction. The findings confirm the role of tobacco smoking in cervical carcinogenesis and show that quitting the habit has important benefits for cancer protection.},
  author       = {Roura, Esther and Castellsague, Xavier and Pawlita, Michael and Travier, Noemie and Waterboer, Tim and Margall, Nuria and Xavier Bosch, F. and de Sanjose, Silvia and Dillner, Joakim and Gram, Inger T. and Tjonneland, Anne and Munk, Christian and Pala, Valeria and Palli, Domenico and Khaw, Kay-Tee and Barnabas, Ruanne V. and Overvad, Kim and Clavel-Chapelon, Francoise and Boutron-Ruault, Marie-Christine and Fagherazzi, Guy and Kaaks, Rudolf and Lukanova, Annekatrin and Steffen, Annika and Trichopoulou, Antonia and Trichopoulos, Dimitrios and Klinaki, Eleni and Tumino, Rosario and Sacerdote, Carlotta and Panico, Salvatore and Bueno-de-Mesquita, H. B(as) and Peeters, Petra H. and Lund, Eiliv and Weiderpass, Elisabete and Luisa Redondo, M. and Sanchez, Maria-Jose and Tormo, Maria-Jose and Barricarte, Aurelio and Larranaga, Nerea and Ekström, Johanna and Hortlund, Maria and Lindquist, David and Wareham, Nick and Travis, Ruth C. and Rinaldi, Sabina and Tommasino, Massimo and Franceschi, Silvia and Riboli, Elio},
  issn         = {0020-7136},
  keyword      = {cohort study,cervical cancer,smoking,Human Papillomavirus serology,EPIC},
  language     = {eng},
  number       = {2},
  pages        = {453--466},
  publisher    = {John Wiley & Sons},
  series       = {International Journal of Cancer},
  title        = {Smoking as a major risk factor for cervical cancer and pre-cancer: Results from the EPIC cohort},
  url          = {http://dx.doi.org/10.1002/ijc.28666},
  volume       = {135},
  year         = {2014},
}