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

被引：169

作者：

Roura, Esther ^{[1
,2
]}

Castellsague, Xavier ^{[1
,2
]}

Pawlita, Michael ^{[3
]}

Travier, Noemie ^{[4
]}

Waterboer, Tim ^{[3
]}

Margall, Nuria ^{[5
]}

Xavier Bosch, F. ^{[1
]}

de Sanjose, Silvia ^{[1
,2
]}

Dillner, Joakim ^{[6
,7
]}

Gram, Inger T. ^{[8
]}

Tjonneland, Anne ^{[9
]}

Munk, Christian ^{[9
]}

Pala, Valeria ^{[10
]}

Palli, Domenico ^{[11
]}

Khaw, Kay-Tee ^{[12
]}

Barnabas, Ruanne V. ^{[13
,14
,15
]}

Overvad, Kim ^{[16
]}

Clavel-Chapelon, Francoise ^{[17
,18
,19
]}

Boutron-Ruault, Marie-Christine ^{[17
,18
,19
]}

Fagherazzi, Guy ^{[17
,18
,19
]}

Kaaks, Rudolf ^{[20
]}

Lukanova, Annekatrin ^{[20
]}

Steffen, Annika ^{[21
]}

Trichopoulou, Antonia ^{[22
,23
]}

Trichopoulos, Dimitrios ^{[22
,24
,25
]}

Klinaki, Eleni ^{[22
]}

Tumino, Rosario ^{[26
,27
]}

Sacerdote, Carlotta ^{[28
]}

Panico, Salvatore ^{[29
]}

Bueno-de-Mesquita, H. B ^{[30
,31
,32
]}

Peeters, Petra H. ^{[30
,33
]}

Lund, Eiliv ^{[8
]}

Weiderpass, Elisabete ^{[7
,8
,34
,35
]}

Luisa Redondo, M. ^{[36
]}

Sanchez, Maria-Jose ^{[2
,37
,38
]}

Tormo, Maria-Jose ^{[2
,39
,40
]}

Barricarte, Aurelio ^{[2
,41
]}

Larranaga, Nerea ^{[2
,42
]}

Ekstrom, Johanna ^{[43
]}

Hortlund, Maria ^{[44
]}

Lindquist, David ^{[45
]}

Wareham, Nick ^{[46
]}

Travis, Ruth C. ^{[47
]}

Rinaldi, Sabina ^{[48
]}

Tommasino, Massimo ^{[48
]}

Franceschi, Silvia ^{[48
]}

Riboli, Elio ^{[30
]}

机构：

[1] Catalan Inst Oncol ICO IDIBELL, Canc Epidemiol Res Program, Unit Infect & Canc, Barcelona, Catalonia, Spain

[2] CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain

[3] German Canc Res Ctr, Infect & Canc Program, Heidelberg, Germany

[4] Catalan Inst Oncol ICO IDIBELL, Canc Epidemiol Res Program, Unit Nutr Environm & Canc, Barcelona, Catalonia, Spain

[5] Univ Autonoma Barcelona, Dept Microbiol, Hosp Santa Creu St & Pau, E-08193 Barcelona, Catalonia, Spain

[6] Karolinska Inst, Dept Lab Med, Stockholm, Sweden

[7] Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden

[8] UiT Arctic Univ Norway, Dept Community Med, Fac Hlth Sci, Tromso, Norway

[9] Danish Canc Soc, Res Ctr, Copenhagen, Denmark

[10] Fdn IRCCS Ist Nazl Tumori, Epidemiol & Prevent Unit, Milan, Italy

[11] Canc Res & Prevent Inst ISPO, Mol & Nutr Epidemiol Unit, Florence, Italy

[12] Univ Cambridge, Cambridge, England

[13] Univ Washington, Dept Med, Seattle, WA USA

[14] Univ Washington, Dept Global Hlth, Seattle, WA 98195 USA

[15] Fred Hutchinson Canc Res Ctr, Vaccine & Infect Dis Inst, Seattle, WA 98104 USA

[16] Aarhus Univ, Dept Publ Hlth, Epidemiol Sect, Aarhus, Denmark

[17] INSERM, Nutr Hormones & Womens Hlth Team, Ctr Res Epidemiol & Populat Hlth CESP, Villejuif, France

[18] Univ Paris 11, Villejuif, France

[19] IGR, Villejuif, France

[20] German Canc Res Ctr, Div Canc Epidemiol, Heidelberg, Germany

[21] German Inst Human Nutr Potsdam Rehbrucke, Dept Epidemiol, Nuthetal, Germany

[22] Hellen Hlth Fdn, Athens, Greece

[23] Univ Athens, Sch Med, Dept Hyg Epidemiol & Med Stat, WHO Collaborating Ctr Food & Nutr Policies, GR-11527 Athens, Greece

[24] Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA

[25] Acad Athens, Bur Epidemiol Res, Athens, Greece

[26] Civ MP Arezzo Hosp, Canc Registry, Ragusa, Italy

[27] Civ MP Arezzo Hosp, Histopathol Unit, Ragusa, Italy

[28] Human Genet Fdn HuGeF, Turin, Italy

[29] Univ Naples Federico II, Dipartimento Med Clin & Chirurg, Naples, Italy

[30] Univ London Imperial Coll Sci Technol & Med, Ctr Environm & Hlth, Sch Publ Hlth, London, England

[31] Natl Inst Publ Hlth & Environm RIVM, Bilthoven, Netherlands

[32] Univ Med Ctr, Dept Gastroenterol & Hepatol, Utrecht, Netherlands

[33] Univ Med Ctr Utrecht, Dept Epidemiol, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[34] Canc Registry Norway, Dept Res, Oslo, Norway

[35] Samfundet Folkhalsan, Helsinki, Finland

[36] Publ Hlth Directorate, Asturias, Spain

[37] Andalusian Sch Publ Hlth, Granada, Spain

[38] Inst Invest Biosanitario Granada Granada Bs, Granada, Spain

[39] Murcia Reg Hlth Council, Dept Epidemiol, Murcia, Spain

[40] Univ Murcia, Dept Hlth & Social Sci, Murcia, Spain

[41] Navarra Publ Hlth Inst, Pamplona, Spain

[42] Reg Govt Basque Country, Publ Hlth Div Gipuzkoa, Bilbao, Spain

[43] Lund Univ, Dept Med Microbiol, Skane Univ Hosp, Malmo, Sweden

[44] Skane Univ Hosp, Dept Clin Microbiol, Malmo, Sweden

[45] Oncol Umea Univ, Dept Radiat Sci, Umea, Sweden

[46] Univ Cambridge, MRC Epidemiol Unit, Cambridge, England

[47] Univ Oxford, Canc Epidemiol Unit, Oxford, England

[48] Int Agcy Res Canc, F-69372 Lyon, France

来源：

INTERNATIONAL JOURNAL OF CANCER | 2014年 / 135卷 / 02期

基金：

英国医学研究理事会;

关键词：

cohort study; cervical cancer; smoking; Human Papillomavirus serology; EPIC; ONCOGENIC HUMAN-PAPILLOMAVIRUS; ORAL-CONTRACEPTIVE USE; CIGARETTE-SMOKING; INTRAEPITHELIAL NEOPLASIA; POOLED ANALYSIS; PASSIVE SMOKING; WOMEN; INFECTION; TYPE-16;

D O I：

10.1002/ijc.28666

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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.

引用

页码：453 / 466

页数：14

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