Hildesheim A, Hadjimichael O, Schwartz P E, Wheeler C M, Barnes W, Lowell D M, Willett J, Schiffman M
National Cancer Institute, Bethesda, Maryland, USA.
Am J Obstet Gynecol. 1999 Mar;180(3 Pt 1):571-7. doi: 10.1016/s0002-9378(99)70256-5.
The current study was designed to elucidate risk factors associated with the development of cervical cancer during the course of routine Papanicolaou smear screening (rapid-onset cervical cancer).
Four hundred eighty-three women diagnosed with invasive cervical cancer, representing 73% of all such tumors diagnosed in Connecticut between 1985 and 1990, were studied. Papanicolaou smear screening and risk factor information was obtained by questionnaire and physician record review. Results from human papillomavirus deoxyribonucleic acid testing by polymerase chain reaction of tumor samples were available for 278 study participants. Prediagnostic Papanicolaou smear slides were reviewed for 67% of cases with a screening history. Screening history information, slide review, and questionnaire data were used to classify women as having rapid-onset cervical cancer (n = 43), possible rapid-onset cervical cancer (n = 111), or normal-onset cervical cancer (n = 329).
Compared with normal-onset cases, rapid-onset cases tended to be younger (P =.001) and were more likely to be white (P =.002), diagnosed with adenocarcinomas or adenosquamous carcinomas (P =.001), and diagnosed with early-stage disease (P =.001). Cases diagnosed as possible rapid-onset disease tended to have a profile that was intermediate to that observed for rapid-onset and normal-onset cases. Human papillomavirus deoxyribonucleic acid was detected in 75.2% of cases tested. Compared with women who tested positive for human papillomavirus type 16 or other, those positive for human papillomavirus type 18 had a relative risk for rapid-onset disease of 1.6 (95% confidence interval 0.52-4.9). No significant association was observed between type 18 and possible rapid-onset disease when possible rapid-onset cases were compared with women diagnosed with normal-onset cervical cancer (relative risk 0.67, 95% confidence interval 0.29-1.6). Oral contraceptive use, cigarette smoking, number of pregnancies, and a maternal history of cervical cancer were not significantly associated with rapid-onset disease.
Results from this study suggest that the risk factors associated with the development of rapid-onset cervical cancer are similar to those for normal-onset disease.
本研究旨在阐明在常规巴氏涂片筛查过程中与快速发病型宫颈癌发生相关的危险因素。
对483例被诊断为浸润性宫颈癌的女性进行了研究，这些病例占1985年至1990年间在康涅狄格州诊断出的所有此类肿瘤的73%。通过问卷调查和医生记录回顾获取巴氏涂片筛查及危险因素信息。278名研究参与者可获得肿瘤样本聚合酶链反应检测人乳头瘤病毒脱氧核糖核酸的结果。对67%有筛查史的病例的诊断前巴氏涂片玻片进行了复查。根据筛查史信息、玻片复查和问卷调查数据，将女性分为快速发病型宫颈癌（n = 43）、可能快速发病型宫颈癌（n = 111）或正常发病型宫颈癌（n = 329）。
与正常发病型病例相比，快速发病型病例往往更年轻（P = 0.001），更可能为白人（P = 0.002），被诊断为腺癌或腺鳞癌（P = 0.001），且被诊断为早期疾病（P = 0.001）。被诊断为可能快速发病型疾病的病例的特征往往介于快速发病型和正常发病型病例之间。在检测的病例中，75.2%检测到人乳头瘤病毒脱氧核糖核酸。与人乳头瘤病毒16型或其他型检测呈阳性的女性相比，人乳头瘤病毒18型检测呈阳性的女性发生快速发病型疾病的相对风险为1.6（95%置信区间0.52 - 4.9）。当将可能快速发病型病例与被诊断为正常发病型宫颈癌的女性进行比较时，未观察到18型与人乳头瘤病毒18型检测呈阳性的女性发生快速发病型疾病的相对风险为1.6（95%置信区间0.52 - 4.9）。当将可能快速发病型病例与被诊断为正常发病型宫颈癌的女性进行比较时，未观察到18型与可能快速发病型疾病之间存在显著关联（相对风险0.67，95%置信区间0.29 - 1.6）。口服避孕药的使用、吸烟、妊娠次数以及宫颈癌家族史与快速发病型疾病无显著关联。
本研究结果表明，与快速发病型宫颈癌发生相关的危险因素与正常发病型疾病相似。
