Open AccessRanking lifestyle risk factors for cervical cancer among Black women: A case-control study from Johannesburg, South Africa
Author(s) -
Mwiza Gideon Singini,
Freddy Sitas,
Debbie Bradshaw,
Wenlong Carl Chen,
Melitah Motlhale,
Abram Bunya Kamiza,
Chantal Babb de Villiers,
Cathryn M. Lewis,
Christopher G. Mathew,
Tim Waterboer,
Robert Newton,
Mazvita Muchengeti,
Elvira Singh
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0260319
Subject(s) - medicine , odds ratio , cervical cancer , case control study , demography , population , confidence interval , logistic regression , cancer , gynecology , environmental health , sociology
Background Aside from human papillomavirus (HPV), the role of other risk factors in cervical cancer such as age, education, parity, sexual partners, smoking and human immunodeficiency virus (HIV) have been described but never ranked in order of priority. We evaluated the contribution of several known lifestyle co-risk factors for cervical cancer among black South African women. Methods We used participant data from the Johannesburg Cancer Study, a case-control study of women recruited mainly at Charlotte Maxeke Johannesburg Academic Hospital between 1995 and 2016. A total of 3,450 women in the study had invasive cervical cancers, 95% of which were squamous cell carcinoma. Controls were 5,709 women with cancers unrelated to exposures of interest. Unconditional logistic regression models were used to calculate adjusted odds ratios (OR adj ) and 95% confidence intervals (CI). We ranked these risk factors by their population attributable fractions (PAF), which take the local prevalence of exposure among the cases and risk into account. Results Cervical cancer in decreasing order of priority was associated with (1) being HIV positive (OR adj = 2.83, 95% CI = 2.53–3.14, PAF = 17.6%), (2) lower educational attainment (OR adj = 1.60, 95% CI = 1.44–1.77, PAF = 16.2%), (3) higher parity (3+ children vs 2–1 children (OR adj = 1.25, 95% CI = 1.07–1.46, PAF = 12.6%), (4) hormonal contraceptive use (OR adj = 1.48, 95% CI = 1.24–1.77, PAF = 8.9%), (5) heavy alcohol consumption (OR adj = 1.44, 95% CI = 1.15–1.81, PAF = 5.6%), (6) current smoking (OR adj = 1.64, 95% CI = 1.41–1.91, PAF = 5.1%), and (7) rural residence (OR adj = 1.60, 95% CI = 1.44–1.77, PAF = 4.4%). Conclunsion This rank order of risks could be used to target educational messaging and appropriate interventions for cervical cancer prevention in South African women.