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Smoking as a major risk factor for cervical cancer and pre‐cancer: Results from the EPIC cohort
Author(s) -
Roura Esther,
Castellsagué Xavier,
Pawlita Michael,
Travier Noémie,
Waterboer Tim,
Margall Núria,
Bosch F. Xavier,
Sanjosé Silvia,
Dillner Joakim,
Gram Inger T.,
Tjønneland Anne,
Munk Christian,
Pala Valeria,
Palli Domenico,
Khaw KayTee,
Barnabas Ruanne V.,
Overvad Kim,
ClavelChapelon Françoise,
BoutronRuault MarieChristine,
Fagherazzi Guy,
Kaaks Rudolf,
Lukanova Annekatrin,
Steffen Annika,
Trichopoulou Antonia,
Trichopoulos Dimitrios,
Klinaki Eleni,
Tumino Rosario,
Sacerdote Carlotta,
Panico Salvatore,
BuenodeMesquita H. Bas,
Peeters Petra H.,
Lund Eiliv,
Weiderpass Elisabete,
Redondo M. Luisa,
Sánchez MaríaJosé,
Tormo MariaJosé,
Barricarte Aurelio,
Larrañaga Nerea,
Ekström Johanna,
Hortlund Maria,
Lindquist David,
Wareham Nick,
Travis Ruth C.,
Rinaldi Sabina,
Tommasino Massimo,
Franceschi Silvia,
Riboli Elio
Publication year - 2014
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.28666
Subject(s) - medicine , serostatus , prospective cohort study , european prospective investigation into cancer and nutrition , risk factor , cervical cancer , cohort , nested case control study , cervical intraepithelial neoplasia , cohort study , gynecology , serology , cancer , oncology , antibody , immunology , viral load , virus
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.