Shapiro Samuel, Carrara Henri, Allan Bruce R, Hoffman Margaret, Rosenberg Lynn, Kelly Judith P, Cooper Diane D, Williamson Anna-Lise
Columbia University, USA.
Cancer Causes Control. 2003 Dec;14(10):953-7. doi: 10.1023/b:caco.0000007966.59285.39.
Based on data collected in a case-control study of hormonal contraceptive use and invasive cervical cancer among South African colored and black women, we have reported a five-fold reduction in incidence among women who in their lifetimes had previously received as few as two Papanicolaou (Pap) smears. Given the conditions prevailing in the community under study, a reduction in risk of this magnitude was surprising. We hypothesized that the act of performing a Pap smear may trigger an immune response to human papillomavirus (HPV) infection and thus reduce the risk of cervical cancer.
Among 1540 control women we compared prevalence rates of infection with specific HPVs known to cause cervical cancer among those who previously received 0, 1, 2 or > or = 3 Pap smears in their lifetimes.
Overall, 16% of the controls were HPV-positive. Among women who received 0, 1, 2 and > or = 3 Pap smears the HPV positivity rates were 24, 17, 12, and 11%, respectively. Compared with never having received a smear, the confounder-adjusted relative risk estimates for the receipt of 1, 2, and > or = 3 smears were 0.7 (95% confidence interval, 0.5-1.0), 0.5 (0.3-0.8). and 0.5 (0.3-0.7), respectively (test for trend among Pap smear recipients: p = 0.04). The data were consistent within strata of age, parity, and race.
The data are compatible with the hypothesis that the minor trauma involved in taking a Pap smear may reduce the risk of cervical cancer by triggering an immune response to HPV infection.
基于一项针对南非有色人种和黑人女性使用激素避孕药与浸润性宫颈癌的病例对照研究收集的数据，我们报告称，一生中仅接受过两次巴氏涂片检查的女性，其发病率降低了五倍。鉴于所研究社区的普遍情况，如此大幅度的风险降低令人惊讶。我们推测，进行巴氏涂片检查的行为可能会引发对人乳头瘤病毒（HPV）感染的免疫反应，从而降低患宫颈癌的风险。
在1540名对照女性中，我们比较了一生中接受过0次、1次、2次或≥3次巴氏涂片检查的女性中，已知会导致宫颈癌的特定HPV感染的患病率。
总体而言，16%的对照者HPV呈阳性。在接受0次、1次、2次和≥3次巴氏涂片检查的女性中，HPV阳性率分别为24%、17%、12%和11%。与从未接受过涂片检查相比，接受1次、2次和≥3次涂片检查的混杂因素调整相对风险估计值分别为0.7（95%置信区间，0.5 - 1.0）、0.5（0.3 - 0.8）和0.5（0.3 - 0.7）（巴氏涂片检查接受者的趋势检验：p = 0.04）。数据在年龄、产次和种族分层中是一致的。
这些数据与以下假设相符，即进行巴氏涂片检查所涉及的轻微创伤可能通过引发对HPV感染的免疫反应来降低患宫颈癌的风险。
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