Herrero R, Brinton L A, Hartge P, Reeves W C, Breñes M M, Urcuyo R, Pacheco M, Fuster F, Sierra R
Unidad Nacional de Cáncer, Hospital San Juan de Dios, San José, Costa Rica.
Bull Pan Am Health Organ. 1993;27(1):15-25.
The incidence of cervical cancer in Costa Rica is about twice as high in the coastal regions as in the interior. To study these regional variations, we used data from a 1986-1987 case-control study of 192 Costa Rican women with invasive cervical cancer and 372 controls. Risk factors identified included the following: The study participant's (1) number of sexual partners, (2) age at first sexual intercourse, (3) number of live births, (4) presence of type 16/18 human papillomavirus (HPV) DNA, (5) venereal disease (VD) history, (6) Pap smear history, and (7) socioeconomic status. The adjusted relative risks (RR) and 95% confidence intervals (CI) for each of these risk factors were as follows: (1) > or = 4 vs. 1 sexual partner: RR = 2.0, 95% CI = 1.1-3.5; (2) age of initiation < or = 15 vs. > or = 18 years: RR = 1.5, 95% CI = 0.9-2.5; (3) > or = 6 vs. < or = 1 live birth: RR = 1.7, 95% CI = 0.7-3.9; (4) HPV 16/18 DNA in cervix: RR = 2.8, 95% CI = 1.9-4.2; (5) VD history: RR = 2.2, 95% CI = 1.2-4.0; (6) no Pap smear: RR = 2.4, 95% CI = 1.5-3.8; and (7) low socioeconomic status: RR = 2.0, 95% CI = 1.2-3.2. The population-attributable risks related to HPV detection, four or more sexual partners, six or more live births, no prior Pap smear, and low socioeconomic status were 39%, 38%, 29%, 23%, and 22%, respectively. Several of the sexual and reproductive risk factors were relatively more prevalent in the high-risk region, but Pap screening and detection of HPV were equally prevalent in the high-risk and low-risk regions. Though differences in screening quality (laboratory and follow-up) may have been involved, we conclude that the observed regional differences reflect behavioral more than screening differences. This suggests that screening programs should be more aggressive in the high-risk area, given the more frequent occurrence of the disease there. Failure to detect a higher prevalence of HPV in the high-risk region could reflect weaknesses in the in situ hybridization test employed. Alternatively, cofactors may have to be present in order for HPV to exert its role in cervical carcinogenesis.
哥斯达黎加沿海地区宫颈癌的发病率约为内陆地区的两倍。为研究这些地区差异，我们使用了1986 - 1987年一项病例对照研究的数据，该研究涉及192名患浸润性宫颈癌的哥斯达黎加女性和372名对照。确定的风险因素包括：研究参与者的（1）性伴侣数量；（2）首次性交年龄；（3）活产数量；（4）16/18型人乳头瘤病毒（HPV）DNA的存在情况；（5）性病（VD）史；（6）巴氏涂片检查史；（7）社会经济地位。这些风险因素各自的调整相对风险（RR）及95%置信区间（CI）如下：（1）性伴侣≥4名与1名相比：RR = 2.0，95%CI = 1.1 - 3.5；（2）开始性行为年龄≤15岁与≥18岁相比：RR = 1.5，95%CI = 0.9 - 2.5；（3）活产≥6次与≤1次相比：RR = 1.7，95%CI = 0.7 - 3.9；（4）宫颈存在HPV 16/18 DNA：RR = 2.8，95%CI = 1.9 - 4.2；（5）有性病病史：RR = 2.2，95%CI = 1.2 - 4.0；（6）未进行巴氏涂片检查：RR = 2.4，95%CI = 1.5 - 3.8；（7）社会经济地位低：RR = 2.0，95%CI = 1.2 - 3.2。与HPV检测、四个或更多性伴侣、六个或更多活产、既往未进行巴氏涂片检查以及社会经济地位低相关的人群归因风险分别为39%、38%、29%、23%和22%。一些性和生殖风险因素在高危地区相对更为普遍，但巴氏筛查和HPV检测在高危和低危地区同样普遍。尽管可能涉及筛查质量（实验室和随访）的差异，但我们得出结论，观察到的地区差异更多地反映了行为差异而非筛查差异。这表明鉴于该疾病在高危地区更频繁发生，筛查项目在高危地区应更积极。在高危地区未能检测到更高的HPV患病率可能反映了所采用的原位杂交检测存在缺陷。或者，可能必须存在辅助因子，HPV才能在宫颈癌发生过程中发挥作用。
