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Is smoking an independent risk factor for invasive cervical cancer? A nested case-control study within Nordic biobanks

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Authors
Kapeu, Aline Simen
Luostarinen, Tapio
Jellum, Egil
Dillner, Joakim
Hakama, Matti
Koskela, Pentti
Lenner, Per
Löve, Arthur
Mahlamaki, Eija
Thoresen, Steinar
Tryggvadottir, Laufey
Wadell, Göran
Youngman, Linda
Lehtinen, Matti
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Issue Date
2009-02-15

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Am. J. Epidemiol. 2009, 169(4):480-8
Abstract
The strong correlation between smoking and exposure to oncogenic human papillomaviruses (HPVs) has made it difficult to verify the independent role of smoking in cervical carcinogenesis. Thus, the authors evaluated this role. Five large Nordic serum banks containing samples from more than 1,000,000 subjects were linked with nationwide cancer registries (1973-2003). Serum samples were retrieved from 588 women who developed invasive cervical cancer and 2,861 matched controls. The samples were analyzed for cotinine (a biomarker of tobacco exposure) and antibodies to HPV types 16 and 18, herpes simplex virus type 2, and Chlamydia trachomatis. Smoking was associated with the risk of squamous cell carcinoma (SCC) among HPV16- and/or HPV18-seropositive heavy smokers (odds ratio=2.7, 95% confidence interval: 1.7, 4.3). A similar risk of SCC (odds ratio=3.2, 95% confidence interval: 2.6, 4.0) was found in heavy smokers after adjustment for HPV16/18 antibodies. The point estimates increased with increasing age at diagnosis and increasing cotinine level. This study confirms that smoking is an independent risk factor for cervical cancer/SCC in women infected with oncogenic HPVs. These findings emphasize the importance of cervical cancer prevention among women exposed to tobacco smoke.
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http://aje.oxfordjournals.org/cgi/content/abstract/169/4/480
ae974a485f413a2113503eed53cd6c53
10.1093/aje/kwn354
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