Danish Cancer Society Research Center, Copenhagen, Denmark.
Cancer Epidemiol Biomarkers Prev. 2012 Nov;21(11):1949-55. doi: 10.1158/1055-9965.EPI-12-0663. Epub 2012 Sep 26.
Smoking has been associated with cervical cancer. We examined whether smoking increases the risk for high-grade cervical lesions in women with high-risk human papillomavirus (HPV) infection.
In a population-based cohort study, 8,656 women underwent a structured interview, and subsequently cervical cells were obtained for HPV DNA testing. Women with high-risk HPV infection and no prevalent cervical disease at baseline (n = 1,353) were followed through the Pathology Data Bank for cervical lesions for up to 13 years. Separate analyses of women with persistent high-risk HPV infection (n = 312) were also conducted. HRs for a diagnosis of cervical intraepithelial neoplasia grade 3 or worse/high-grade squamous intraepithelial lesions or worse (CIN3+) and the corresponding 95% confidence intervals (CI) were calculated in the two groups.
Among high-risk HPV-positive women, an increased risk for CIN3+ was associated with long-term smoking (≥10 years) and heavy smoking (≥20 cigarettes/d). In the subgroup of women with persistent HPV infection, heavy smoking was also associated with a statistically significantly higher risk for CIN3+ than never smoking (HR, 1.85; 95% CI, 1.05-3.22, adjusted for length of schooling, parity, and HPV type at baseline). The average number of cervical cytology screening tests per year during follow-up did not explain the differences in risk in relation to smoking (P = 0.4).
Smoking is associated with an increased risk for subsequent high-grade cervical lesions in women with persistent high-risk HPV infection.
Our study adds to the understanding of the role of smoking in the natural history of HPV and cervical carcinogenesis.
吸烟与宫颈癌有关。我们研究了吸烟是否会增加高危型人乳头瘤病毒（HPV）感染女性发生高级别宫颈病变的风险。
在一项基于人群的队列研究中，8656 名女性接受了结构化访谈，随后采集宫颈细胞进行 HPV DNA 检测。基线时患有高危型 HPV 感染且无现有宫颈疾病的女性（n=1353）通过病理学数据库进行了长达 13 年的宫颈病变随访。还对持续感染高危型 HPV 的女性（n=312）进行了单独分析。在这两组人群中，计算了诊断为宫颈上皮内瘤变 3 级或更高级别（CIN3+）及高级别鳞状上皮内病变或更高级别（CIN3+）的风险比（HR）及其 95%置信区间（CI）。
在高危型 HPV 阳性女性中，长期吸烟（≥10 年）和重度吸烟（≥20 支/天）与 CIN3+风险增加相关。在持续 HPV 感染的女性亚组中，重度吸烟与 CIN3+的风险也显著高于从不吸烟（HR，1.85；95%CI，1.05-3.22，调整了受教育程度、产次和基线时的 HPV 类型）。在随访期间，每年接受宫颈细胞学筛查的平均次数并不能解释吸烟与风险之间的差异（P=0.4）。
吸烟与持续感染高危型 HPV 的女性发生高级别宫颈病变的风险增加相关。
本研究增加了对吸烟在 HPV 自然史和宫颈癌发生中的作用的理解。
