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Hormonal contraceptive use and smoking as risk factors for high-grade cervical intraepithelial neoplasia in unvaccinated women aged 30-44 years: A case-control study in New South Wales, Australia

Xu, Huilan; Egger, Sam; Velentzis, Louiza; O'Connell, Dianne; Banks, Emily; Darlington-Brown, Jessica; Canfell, Karen; Sitas, Freddy

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Background: 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...[Show more]

dc.contributor.authorXu, Huilan
dc.contributor.authorEgger, Sam
dc.contributor.authorVelentzis, Louiza
dc.contributor.authorO'Connell, Dianne
dc.contributor.authorBanks, Emily
dc.contributor.authorDarlington-Brown, Jessica
dc.contributor.authorCanfell, Karen
dc.contributor.authorSitas, Freddy
dc.date.accessioned2019-07-03T05:40:58Z
dc.identifier.issn1877-7821
dc.identifier.urihttp://hdl.handle.net/1885/164336
dc.description.abstractBackground: 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. Methods: 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. Results: 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). Conclusions: 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.
dc.description.sponsorshipFunding for the study was provided by the National Health and Medical Research Council (NHMRC) Grant no. 337600.
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherElsevier
dc.rights© 2018 Elsevier Ltd
dc.sourceCancer Epidemiology
dc.titleHormonal contraceptive use and smoking as risk factors for high-grade cervical intraepithelial neoplasia in unvaccinated women aged 30-44 years: A case-control study in New South Wales, Australia
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume55
dc.date.issued2018
local.identifier.absfor111706 - Epidemiology
local.identifier.absfor111711 - Health Information Systems (incl. Surveillance)
local.identifier.ariespublicationa383154xPUB10392
local.publisher.urlhttps://www.elsevier.com/en-au
local.type.statusPublished Version
local.contributor.affiliationXu, Huilan, University of Sydney
local.contributor.affiliationEgger, Sam, Cancer Council NSW
local.contributor.affiliationVelentzis, Louiza, Cancer Council NSW
local.contributor.affiliationO'Connell, Dianne, Cancer Council NSW
local.contributor.affiliationBanks, Emily, College of Health and Medicine, ANU
local.contributor.affiliationDarlington-Brown, Jessica, Cancer Council NSW
local.contributor.affiliationCanfell, Karen, Cancer Counsil NSW
local.contributor.affiliationSitas, Freddy, University of Sydney
local.description.embargo2037-12-31
dc.relationhttp://purl.org/au-research/grants/nhmrc/337600
local.bibliographicCitation.startpage162
local.bibliographicCitation.lastpage169
local.identifier.doi10.1016/j.canep.2018.05.013
local.identifier.absseo920507 - Women's Health
local.identifier.absseo920204 - Evaluation of Health Outcomes
dc.date.updated2019-03-31T07:17:53Z
local.identifier.scopusID2-s2.0-85049356836
CollectionsANU Research Publications

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