Xu Huilan, Egger Sam, Velentzis Louiza S, O'Connell Dianne L, Banks Emily, Darlington-Brown Jessica, Canfell Karen, Sitas Freddy
Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia.
Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, NSW, Australia.
Cancer Epidemiol. 2018 Aug;55:162-169. doi: 10.1016/j.canep.2018.05.013. Epub 2018 Jul 3.
Human papillomavirus (HPV) vaccines protect against HPV types 16/18, but do not eliminate the need to detect pre-cancerous lesions. Australian women vaccinated as teenage girls are now entering their mid-thirties. Since other oncogenic HPV types have been shown to be more prevalent in women ≥30 years old, understanding high grade cervical lesions in older women is still important. Hormonal contraceptives (HC) and smoking are recognised cofactors for the development of pre-malignant lesions.
886 cases with cervical intraepithelial neoplasia (CIN) 2/3 and 3636 controls with normal cytology were recruited from the Pap Test Register of NSW, Australia. All women were aged 30-44 years. Conditional logistic regression was used to quantify the relationship of HC and smoking to CIN 2/3 adjusted for various factors.
Current-users of HC were at higher risk for CIN 2/3 than never-users [odds ratio (OR) = 1.50, 95%CI = 1.03-2.17] and risk increased with increasing duration of use [ORs:1.13 (0.73-1.75), 1.51 (1.00-2.72), 1.82 (1.22-2.72) for <10, 10-14, ≥15 years of use; p-trend = 0.04]. Ex-users had risks similar to never-users (OR 1.08, 95%CI = 0.75-1.57) regardless of duration of use. Current smoking was significantly associated with CIN 2/3 (OR = 1.43, 95%CI = 1.14-1.80) and risk increased with increasing number of cigarettes/day (p-trend = 0.02). Among ex-smokers, the risk of CIN 2/3 decreased with increasing time since quitting (p-trend = 0.04).
In this benchmark study, current, long term users of HC and current smokers of ≥5 cigarettes/day were each at increased risk of developing CIN 2/3. Findings support smoking cessation in relation to decreasing the risk of pre-cancerous lesions and reinforce the continuing need for cervical screening for cancer prevention in vaccinated and unvaccinated populations.
人乳头瘤病毒（HPV）疫苗可预防16/18型HPV，但并不能消除检测癌前病变的必要性。在少女时期接种疫苗的澳大利亚女性如今已步入35岁左右。由于其他致癌性HPV类型在30岁及以上女性中更为普遍，因此了解老年女性的高级别宫颈病变仍然很重要。激素避孕药（HC）和吸烟是公认的癌前病变发展的辅助因素。
从澳大利亚新南威尔士州巴氏试验登记处招募了886例宫颈上皮内瘤变（CIN）2/3患者和3636例细胞学正常的对照者。所有女性年龄在30至44岁之间。采用条件逻辑回归来量化HC和吸烟与经各种因素调整后的CIN 2/3之间的关系。
当前使用HC的女性患CIN 2/3的风险高于从未使用者[比值比（OR）=1.50，95%置信区间（CI）=1.03 - 2.17]，且风险随着使用时间的延长而增加[使用时间<10年、10 - 14年、≥15年的OR分别为：1.13（0.73 - 1.75）、1.51（1.00 - 2.72）、1.82（1.22 - 2.72）；趋势p值=0.04]。既往使用者的风险与从未使用者相似（OR 1.08，95%CI = 0.75 - 1.57），与使用时间无关。当前吸烟与CIN 2/3显著相关（OR = 1.43，95%CI = 1.14 - 1.80），且风险随着每日吸烟量的增加而增加（趋势p值=0.02）。在既往吸烟者中，CIN 2/3的风险随着戒烟时间的延长而降低（趋势p值=0.04）。
在这项基准研究中，当前长期使用HC的女性和每日吸烟≥5支的当前吸烟者患CIN 2/3的风险均增加。研究结果支持戒烟以降低癌前病变风险，并强化了在接种疫苗和未接种疫苗人群中持续进行宫颈癌筛查以预防癌症的必要性。
