Centre for Cancer Prevention, Queen Mary University of London Wolfson Institute of Preventive Medicine, London, UK.
Int J Gynecol Cancer. 2011 Dec;21(9):1654-63. doi: 10.1097/IGC.0b013e3182288104.
To evaluate the association between potential risk factors for high-risk human papillomavirus (HR-HPV) infection and cofactors for cervical intraepithelial lesions grade 2 or worse (CIN2+) in women attending cervical screening in Amazonian Peru.
Participants completed a risk factor questionnaire before screening. High-risk human papillomavirus infection was determined by Hybrid Capture II. Logistic regression was used to evaluate associations between potential risk factors for HR-HPV infection and between cofactors and risk of CIN2+ among women with HR-HPV infection.
Screening and questionnaires were completed by 5435 women aged 25 to 49 years. The prevalence of HR-HPV was 12.6% (95% confidence interval [CI], 11.8%-13.6%) and decreased by age. Early age at first sexual intercourse and several lifetime sexual partners increased the risk of having HR-HPV (age-adjusted odds ratio [AOR] of age at first sexual intercourse <18 vs ≥20, 1.5; 95% CI, 1.2-2.0; AOR of ≥5 lifetime sexual partners vs 1, 2.1; 95% CI, 1.4-3.2). Among women with HR-HPV infection, those with no schooling (AOR relative to 1-5 years of schooling, 3.2; 95% CI, 1.3-8.3) and those with parity ≥3 (AOR relative to parity <3, 2.6; 95% CI, 1.4-4.9) were at increased risk of CIN2+. The effect of parity was stronger for cancer (AOR of parity ≥3 vs <3, 8.3; 95% CI, 1.0-65.6). Further analysis showed that the association between parity and CIN2+ was restricted to women younger than 40. Most women (83%) had previously been screened. Sixty-four percent of CIN2+ cases detected in this study occurred in women who reported having had a Papanicolaou test in the previous 3 years. Only 4 of 20 cancers were detected in women never screened before. Having had a previous abnormal Papanicolaou test increased the risk of CIN2+ (OR, 16.1; 95% CI, 6.2-41.9).
Among women with HR-HPV, high parity (in young women), no schooling, lack of good-quality screening and of adequate follow-up care are the main risk factors for high-grade cervical disease in Peru.
评估在亚马逊秘鲁进行宫颈筛查的女性中，高危型人乳头瘤病毒（HR-HPV）感染的潜在危险因素与宫颈上皮内瘤变 2 级或更高级别（CIN2+）的相关因素。
参与者在筛查前完成了危险因素问卷。通过杂交捕获 II 法确定 HR-HPV 感染。采用 logistic 回归评估 HR-HPV 感染潜在危险因素之间以及 HR-HPV 感染妇女中相关因素与 CIN2+风险之间的关联。
对 5435 名 25 至 49 岁的女性进行了筛查和问卷调查。HR-HPV 的患病率为 12.6%（95%置信区间 [CI]，11.8%-13.6%），并随年龄下降。初次性行为年龄较小和多个性伴侣增加了感染 HR-HPV 的风险（初次性行为年龄<18 岁与≥20 岁相比，调整后的优势比 [AOR]为 1.5；95%CI，1.2-2.0；AOR≥5 个性伴侣与 1 个性伴侣相比为 2.1；95%CI，1.4-3.2）。在感染 HR-HPV 的女性中，未受过教育（与 1-5 年受教育程度相比，AOR 为 3.2；95%CI，1.3-8.3）和多产（与产次<3 相比，AOR 为 2.6；95%CI，1.4-4.9）的女性患 CIN2+的风险增加。产次对癌症的影响更强（产次≥3 与<3 相比，AOR 为 8.3；95%CI，1.0-65.6）。进一步的分析表明，产次与 CIN2+之间的关联仅限于年龄<40 岁的女性。大多数女性（83%）曾接受过筛查。在本研究中发现的 64%的 CIN2+病例发生在报告过去 3 年内曾进行巴氏涂片检查的女性中。只有 20 例癌症中的 4 例发生在从未接受过筛查的女性中。既往巴氏涂片异常检查增加了 CIN2+的风险（OR，16.1；95%CI，6.2-41.9）。
在感染 HR-HPV 的女性中，高产次（年轻女性）、未受教育、缺乏高质量的筛查和充分的随访是秘鲁发生高级别宫颈癌的主要危险因素。
