National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.
Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
PLoS One. 2021 Dec 8;16(12):e0260319. doi: 10.1371/journal.pone.0260319. eCollection 2021.
Aside from human papillomavirus (HPV), the role of other risk factors in cervical cancer such as age, education, parity, sexual partners, smoking and human immunodeficiency virus (HIV) have been described but never ranked in order of priority. We evaluated the contribution of several known lifestyle co-risk factors for cervical cancer among black South African women.
We used participant data from the Johannesburg Cancer Study, a case-control study of women recruited mainly at Charlotte Maxeke Johannesburg Academic Hospital between 1995 and 2016. A total of 3,450 women in the study had invasive cervical cancers, 95% of which were squamous cell carcinoma. Controls were 5,709 women with cancers unrelated to exposures of interest. Unconditional logistic regression models were used to calculate adjusted odds ratios (ORadj) and 95% confidence intervals (CI). We ranked these risk factors by their population attributable fractions (PAF), which take the local prevalence of exposure among the cases and risk into account.
Cervical cancer in decreasing order of priority was associated with (1) being HIV positive (ORadj = 2.83, 95% CI = 2.53-3.14, PAF = 17.6%), (2) lower educational attainment (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 16.2%), (3) higher parity (3+ children vs 2-1 children (ORadj = 1.25, 95% CI = 1.07-1.46, PAF = 12.6%), (4) hormonal contraceptive use (ORadj = 1.48, 95% CI = 1.24-1.77, PAF = 8.9%), (5) heavy alcohol consumption (ORadj = 1.44, 95% CI = 1.15-1.81, PAF = 5.6%), (6) current smoking (ORadj = 1.64, 95% CI = 1.41-1.91, PAF = 5.1%), and (7) rural residence (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 4.4%).
This rank order of risks could be used to target educational messaging and appropriate interventions for cervical cancer prevention in South African women.
除了人乳头瘤病毒（HPV）之外，其他一些风险因素，如年龄、教育程度、生育史、性伴侣数量、吸烟和人类免疫缺陷病毒（HIV）等，在宫颈癌中的作用也已经被描述过，但从未按优先顺序进行过排序。我们评估了南非黑人妇女中几种已知的宫颈癌生活方式共同风险因素的作用。
我们使用了约翰内斯堡癌症研究（Jo hannesburg Cancer Study）的参与者数据，这是一项针对女性的病例对照研究，主要在 1995 年至 2016 年期间在夏洛特·马克斯凯 Johannesburg 学术医院招募参与者。研究中有 3450 名女性患有浸润性宫颈癌，其中 95%为鳞状细胞癌。对照组为 5709 名患有与研究中暴露无关的癌症的女性。使用非条件逻辑回归模型计算调整后的优势比（ORadj）和 95%置信区间（CI）。我们根据其人群归因分数（PAF）对这些风险因素进行了排序，该分数考虑了病例中暴露的局部流行率和风险。
宫颈癌的风险因素按优先顺序依次为：（1）HIV 阳性（ORadj=2.83，95%CI=2.53-3.14，PAF=17.6%）；（2）教育程度较低（ORadj=1.60，95%CI=1.44-1.77，PAF=16.2%）；（3）多产（3 个及以上孩子 vs 2-1 个孩子（ORadj=1.25，95%CI=1.07-1.46，PAF=12.6%）；（4）激素避孕（ORadj=1.48，95%CI=1.24-1.77，PAF=8.9%）；（5）大量饮酒（ORadj=1.44，95%CI=1.15-1.81，PAF=5.6%）；（6）当前吸烟（ORadj=1.64，95%CI=1.41-1.91，PAF=5.1%）；（7）居住在农村（ORadj=1.60，95%CI=1.44-1.77，PAF=4.4%）。
这种风险排序可以用于针对南非女性的宫颈癌预防，制定有针对性的教育信息和适当的干预措施。
