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Prospective study of human papillomavirus and risk of cervical adenocarcinoma

Dahlstrom, Lisen Arnheim; Ylitalo, Nathalie; Sundstrom, Karin; Palmgren, Juni; Ploner, Alexander; Eloranta, Sandra; Sanjeevi, Carani B.; Andersson, Sonia; Rohan, Thomas and Dillner, Joakim LU , et al. (2010) In International Journal of Cancer 127(8). p.1923-1930
Abstract
Human papillomaviruses (HPV) are established as a major cause of cervical carcinoma. However, causality inference is dependent on prospective evidence showing that exposure predicts risk for future disease. Such evidence is available for squamous cell carcinoma, but not for cervical adenocarcinoma. We followed a population-based cohort of 994,120 women who participated in cytological screening in Sweden for a median of 6.7 years. Baseline smears from women who developed adenocarcinoma during follow-up (118 women with in situ disease and 164 with invasive disease) and their individually matched controls (1,434 smears) were analyzed for HPV using PCR. Conditional logistic regression was used to estimate odds ratios (OR) of future... (More)
Human papillomaviruses (HPV) are established as a major cause of cervical carcinoma. However, causality inference is dependent on prospective evidence showing that exposure predicts risk for future disease. Such evidence is available for squamous cell carcinoma, but not for cervical adenocarcinoma. We followed a population-based cohort of 994,120 women who participated in cytological screening in Sweden for a median of 6.7 years. Baseline smears from women who developed adenocarcinoma during follow-up (118 women with in situ disease and 164 with invasive disease) and their individually matched controls (1,434 smears) were analyzed for HPV using PCR. Conditional logistic regression was used to estimate odds ratios (OR) of future adenocarcinoma with 95% confidence intervals (CI). Being positive for HPV 16 in the first cytologically normal smear was associated with increased risks for both future adenocarcinoma in situ (OR: 11.0, 95% CI: 2.6-46.8) and invasive adenocarcinoma (OR: 16.0, 95% CI: 3.8-66.7), compared to being negative for HPV 16. Similarly, an HPV 18 positive smear was associated with increased risks for adenocarcinoma in situ (OR: 26.0, 95% CI: 3.5-192) and invasive adenocarcinoma (OR: 28.0, 95% CI: 3.8-206), compared to an HPV 18 negative smear. Being positive for HPV 16/18 in 2 subsequent smears was associated with an infinite risk of both in situ and invasive adenocarcinoma. In conclusion, infections with HPV 16 and 18 are detectable up to at least 14 years before diagnosis of cervical adenocarcinoma. Our data provide prospective evidence that the association of HPV 16/18 with cervical adenocarcinoma is strong and causal. (Less)
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publication status
published
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keywords
cervical cancer, HPV, adenocarcinoma, adenocarcinoma in situ, prospective
in
International Journal of Cancer
volume
127
issue
8
pages
1923 - 1930
publisher
John Wiley & Sons
external identifiers
  • wos:000282404900019
  • scopus:77956992491
ISSN
0020-7136
DOI
10.1002/ijc.25408
language
English
LU publication?
yes
id
45cbd5bd-e066-4cc1-91e6-ad268f614495 (old id 1695058)
date added to LUP
2010-10-27 11:30:58
date last changed
2018-10-14 03:08:25
@article{45cbd5bd-e066-4cc1-91e6-ad268f614495,
  abstract     = {Human papillomaviruses (HPV) are established as a major cause of cervical carcinoma. However, causality inference is dependent on prospective evidence showing that exposure predicts risk for future disease. Such evidence is available for squamous cell carcinoma, but not for cervical adenocarcinoma. We followed a population-based cohort of 994,120 women who participated in cytological screening in Sweden for a median of 6.7 years. Baseline smears from women who developed adenocarcinoma during follow-up (118 women with in situ disease and 164 with invasive disease) and their individually matched controls (1,434 smears) were analyzed for HPV using PCR. Conditional logistic regression was used to estimate odds ratios (OR) of future adenocarcinoma with 95% confidence intervals (CI). Being positive for HPV 16 in the first cytologically normal smear was associated with increased risks for both future adenocarcinoma in situ (OR: 11.0, 95% CI: 2.6-46.8) and invasive adenocarcinoma (OR: 16.0, 95% CI: 3.8-66.7), compared to being negative for HPV 16. Similarly, an HPV 18 positive smear was associated with increased risks for adenocarcinoma in situ (OR: 26.0, 95% CI: 3.5-192) and invasive adenocarcinoma (OR: 28.0, 95% CI: 3.8-206), compared to an HPV 18 negative smear. Being positive for HPV 16/18 in 2 subsequent smears was associated with an infinite risk of both in situ and invasive adenocarcinoma. In conclusion, infections with HPV 16 and 18 are detectable up to at least 14 years before diagnosis of cervical adenocarcinoma. Our data provide prospective evidence that the association of HPV 16/18 with cervical adenocarcinoma is strong and causal.},
  author       = {Dahlstrom, Lisen Arnheim and Ylitalo, Nathalie and Sundstrom, Karin and Palmgren, Juni and Ploner, Alexander and Eloranta, Sandra and Sanjeevi, Carani B. and Andersson, Sonia and Rohan, Thomas and Dillner, Joakim and Adami, Hans-Olov and Sparen, Par},
  issn         = {0020-7136},
  keyword      = {cervical cancer,HPV,adenocarcinoma,adenocarcinoma in situ,prospective},
  language     = {eng},
  number       = {8},
  pages        = {1923--1930},
  publisher    = {John Wiley & Sons},
  series       = {International Journal of Cancer},
  title        = {Prospective study of human papillomavirus and risk of cervical adenocarcinoma},
  url          = {http://dx.doi.org/10.1002/ijc.25408},
  volume       = {127},
  year         = {2010},
}