Risk factors for invasive carcinoma of the uterine cervix in Latin America
Herrero, R.; Brinton, L.A.; Reeves, W.C.; Brenes, M.M.; Tenorio, F.; de Britton, R.C.; Gaitán, E.; Montalván, P.; García, M.; Rawls, W.E.
Bulletin of the Pan American Health Organization 24(3): 263-283
1990
ISSN/ISBN: 0085-4638 PMID: 2171706 Document Number: 373208
Risk factors for invasive carcinoma of the cervix were analyzed in 759 cancer patients from Mexico City, Costa Rica, Panama and Bogota, Colombia, in comparison with 1430 controls and 689 male partners, by interview and analysis for human papilloma virus (HPV) types 16 and 18. Community and hospital controls were combined for the analysis, since they did not differ significantly. Average age is 1st coitus was 17.4 years for patients and 18.8 for controls. A relative risk of 1.8 resulted for women with coitus at age 14-15 compared to age 20 or more. Those with 6 or more sex partners had a risk of 1.7 compared to monogamous women, with a significant trend (p0.0001). Anal sex conferred a risk of 1.5-1.9 depending on frequency. There was a significant trend toward increasing risk for number of pregnancies up to 5.1 for 14 or more pregnancies, and especially for number of live births, with a risk of 3.7 for 12 of more. No relationship was found between risk and stillbirths, or spontaneous or induced abortions. Cesarean sections and prenatal care reduced risks. DNA from HPV types 16 or 18 was found in 62% of patients and 32% of controls. A relative risk of 1.7 was found in women who had HPV and who smoked. Risks decreased with rising educational level, and with increasing socioeconomic status. Neither oral contraception nor condoms affected risks. Factors associated with male partners related to increased risk were his number of sex partners (25 vs 5 of less) and lower education. Not having Pap smears increased risk to 2.5. Providing cervical cytology to women at risk is an obvious intervention needed to reduce the several-fold higher incidence of cervical cancer in Latin American compared to that in developed countries.