Risk factors for cancer cervix: a case control study.

The present hospital based, group matched case control study was carried out at Gynaecology clinic, Govt. Medical College Hospital, Nagpur, to study risk factors for cancer cervix and investigate their independent and interactive role in the outcome of cervical cancer. The study included 230 cases of cancer cervix and equal number of controls, group matched for age. Univariate analysis included 17 hypothesised risk factors for cancer cervix and identified significance of 10 risk factors. However multiple logistic regression (MLR) analysis recognised and confirmed the significance of illiteracy, poor genital hygiene, long duration of married life, multiparity and early menarche in the ultimate outcome of cancer cervix. Estimates of Attributable Risk Proportions (ARP) and Population Attributable Risk Proportion (PARP) endorsed the etiological and preventable role of these risk factors, respectively. Considering the public health impact of elimination of these risk factors on the cancer cervix problem in this population, development of a preventive strategy based on these risk factors would be an appropriate step towards curtailment of this "Biggest Scourge of womankind".     

Epidemiology of cervical cancer--a case control study on north Indian population

The present case control study on married women with cervical cancer and controls (100 each) revealed the association of age at marriage, socioeconomic status, education status and parity with cervical cancer but young age at marriage (rr 3.79) and low socioeconomic status (rr -3.81) emerged as independent predictors of disease status.     

Assessment of risk patterns in cancer of the cervix: a comparison between greater Bombay and western countries

In order to identify the high-risk groups in the community, a retrospective study of 503 women with histologically proved invasive carcinoma of the uterine cervix was undertaken and the results were compared with a similar appraisal of an equal number of controls closely matched for age, religion and income, in order to examine certain risk factors suspected of being of aetiological importance in patients with cervical cancer. We have sought to estimate the effects of parity, and of age at first marriage, first delivery and last delivery. The highest risk was observed in women who had undergone several pregnancies early in life. It is interesting to note that multiparity was one of the important risk factors in Bombay women, in contrast with the situation reported in Western countries.     

Community-based Screening of Cervical Cancer in a Low Prevalence Area of India: A Cross sectional Study

Cervical cancer is the second most common cancer of women in the world. The disease is amenable to variousscreening tests of which cytological screening by the Papanicolaou technique remains the mainstay for massscreening. The aim of the present study was to establish the prevalence of cervical cancer in a rural ethnicallyMuslim community of state of Jammu and Kashmir in India. For this, a community based screening for cancercervix was conducted on married women aged 20-65 years. Following provision of information to promoteawareness of the Papanicolau smear and its role in prevention of cervical cancer, 270 women were screened forcancer cervix by the conventional technique. Of the 270 subjects, the majority were married before 19 years ofage (81.1%) and 42.5% delivered their first child within 1-2 years . Multiparity was seen to the tune of 51.3 %.There was no evidence of cervical dysplasia or cancer cervix among the screened population. Despite the presenceof risk factors of high parity, early age of marriage and early childbirth after marriage, absence of cervicaldysplasia and malignancy emphasizes the fact that socio-cultural factors, like absence of promiscuity and malecircumcision, play an important role in the low prevalence of cancer cervix.     

Reproductive factors and risk of cervical cancer by cell type. A prospective study

Relationships between reproductive variables and risk of cervical cancer were examined in a follow-up of 62,079 women in Norway from 1961 through 1980. For the 342 cases classified as squamous cell carcinomas, a higher risk was observed in ever married than in never married women. The risk was especially high among women married more than once and women who were widowed or divorced before start of follow-up. High age at first birth was associated with low risk. The estimated odds ratio for women with first birth at age 35 years or later versus 19 years or earlier was 0.18 (P less than 0.001) in analyses with adjustment for age, urban-rural place of residence and parity. In analyses with adjustment for age at first birth, neither parity or age at first marriage, nor age at menarche or menopause showed significant associations with squamous cell carcinoma. For the 30 cases classified as adenocarcinomas, no significant associations emerged with reproductive factors. The effects of marital status as well as age at first birth differed significantly between adenocarcinomas and squamous cell carcinomas, suggesting dissimilar aetiologies. Although associations between reproductive factors and squamous cell carcinoma may largely be secondary to relationships with sexual habits, there are indications that the association with age at first birth cannot be entirely explained in this way.     

Long-term population-based marriage rates among adult survivors of childhood cancer in Britain

The objectives of this study were to assess the number of adult survivors of childhood cancer who ever married and the factors influencing marriage, compare observed marriages to those expected from the general population, and assess age at marriage and influencing factors. The data is based on the British Childhood Cancer Survivor Study (BCCSS), which is a population-based cohort of 18,119 individuals who were diagnosed with childhood cancer between 1940 and 91 and survived at least 5 years. Fourteen thousand five hundred thirty-nine were alive, aged at least 16 years and eligible to receive a postal questionnaire, which ascertained marriage status. Thirty-four percent of 9,954 survivors had married. Survivors with the following characteristics: males, CNS neoplasm, received radiotherapy, diagnosed with mental retardation, registered blind, low social functioning score (calculated from SF-36 health status measure), and achieved the highest level of educational attainment, were less likely to have married than the complementary survivor groups. The deficits in the proportion ever married compared to the general population were mostly between 9 and 18% among males and 7-10% among females. The largest ever married deficits were among male CNS neoplasm survivors aged 30 years or over (29-38%). Age at first marriage among survivors was related to: sex, childhood cancer type, age at diagnosis, chemotherapy, radiotherapy, mental retardation, and level of educational attainment. Regular follow-up for these survivors should address not just physical late-effects of the childhood cancer and treatment, but also psychosocial needs throughout the lifespan of the survivors to help them achieve life events as they occur in the general population.     

Epidemiology of cancer of the cervix in greater bombay

An attempt has been made to study in depth the cervical cancer problem in Greater Bombay by undertaking epidemiological investigations to identify its aetiology, by utilising the data collected by the Bombay Cancer Registry. Although cancer of the uterine cervix is found to occur at all ages in Bombay, it is mainly seen during middle age. Its incidence is highest in the Hindu community and lowest in the Parsi. This neoplasm appears to have a strong association with the degree of sexual activity. Thus it is rarely seen in nuns, and commonly found in women who have had multiple sexual partners. There is also a relative preponderance in the poorer, uneducated section of the community. In order to identify the high-risk groups, a retrospective study was undertaken of proven cases of cancer of the uterine cervix. The results were compared with those of similar controls, equal in number and closely matched for age, religion, and income, in order to examine the risk factors of possible aetiological importance in women with cervical cancer. We have sought to estimate the effects of parity, the age at first marriage and at first delivery. The highest risk was observed in women who had had multiple pregnancies early in life. It is interesting to note that multiparity seems to be an important risk factor in Bombay women, in contrast to the Western experience.     

Epidemiologic study by interview on carcinoma in situ of the cervix uteri

From 1950 to 1979, 1248 patients with cancer in situ of the cervix uteri were treated at the Department of Gynecology, Cancer Institute Hospital, Tokyo. Information was obtained from 585 of these patients by direct interview. Many patients revealed early experience of first sexual intercourse and many had had more than two sexual partners and a large discrepancy between the age at first sexual intercourse and at first marriage. Early experience of first sexual intercourse, marital status and the number of sexual partners all seem to have a relation to the development of cancer in situ.     

Cervical Cancer Prevention and Early Detection; The Role of Nurse and Midwives

Worldwide 31% of cancers in women are in the breast or uterine cervix. Cancer of the uterine cervix is one of the ‍leading causes of cancer death among women. The estimated new cancer cervix cases per year is 500.000 of which ‍79% occur in the developing countries, where it is consistently the leading cancer and there are in excess of 233.000 ‍deaths from the disease. The major risk factors for cervical cancer include early age at first intercourse, multiple ‍sexual partners, low socioeconomic status, HSV, HPV infection, cigarette smoking and extended use of oral ‍contraceptives. Well organized and applied public education and mass screening programmes can substantially ‍reduce the mortality from cervical cancer and the incidence of invasive disease in the population. Women who are ‍health conscious are more likely to have used screening services (mammogram, pap-smear test) and performed ‍breast-self examination and genital hygiene. There are both opportunities and burdens for nurses and midwives ‍working in primary health care settings. This is a prime example of a role of public education in cancer prevention ‍with reference to population-based cancer screening programs. ‍     

Risk factors for high-risk type human papillomavirus infection among Mexican-American women.

Minority women in the United States experience a disproportionately high burden of the more than 2 million yearly cases of squamous intraepithelial lesions of the cervix. Risk factors for squamous intraepithelial lesions of the cervix are infection with the sexually acquired human papillomavirus (HPV), an early age at first intercourse, history of multiple sexual partners, oral contraceptive use, high parity, lower socioeconomic status, poor diet, immunosuppression, and promiscuous male sexual partners. Although Hispanics are the largest growing minority population in the United States, few HPV risk factor studies have either included or focused on Hispanics in the United States. To determine risk factors for HPV infection among Mexican-American women, we conducted a cross-sectional study from 1992-1995. Nine hundred and seventy-one women, 18-47 years of age, with cytology results were included in this analysis. Overall, 13.2% of participants were HPV positive by the Hybrid Capture tube method for high-risk types 16, 18, 31, 33, 35, 45, 51, 52, or 56. Age [adjusted odds ratio (AOR) = 0.3 for ages >36 years compared with ages 18-20] and duration of oral contraceptive use (AOR = 0.4 for > or =4 years relative to nonusers) were inversely associated with these high-risk types of HPV infection. Marital status (AOR = 1.9 among single women compared with married) and lifetime number of sexual partners (AOR = 2.3 for women > or =5 partners relative to monogamous women) were positively associated with an increased risk. Participants born in Mexico were significantly (P < 0.05) older, had fewer sex partners, and older age at first intercourse. Despite this lower behavioral risk profile, women born in Mexico were significantly more likely (AOR = 1.9; CI = 1.2-3.2) to have an HPV infection compared with United States-born, Mexican-American women after adjustment for potential confounders. Collectively, these results suggest that an unmeasured factor, such as the sexual behavior of the male partner, may be influencing HPV risk. Further research is needed to define this factor and to assess cultural norms of sexual behavior.     

A case-control study of reproductive risk factors associated with cervical cancer

Using the logistic-regression technique, a hospital-based case-control study of 177 married women with invasive squamous-cell cervical cancer and 149 hospital-visiting controls enabled evaluation of selected reproductive factors as risks. Early age at marriage was found to be the single best predictor of the disease status. However, those who married late but gave birth to a large number of children were generally found to be suffering from cervical cancer. The results support the hypothesis that it is not so much parity per se that enhances the risk, but the rapidity of multiple pregnancies that matters. Logistic analysis also revealed the independent influence of birth interval on the risk of cervical cancer. These findings warrant serious consideration in future studies, given the obvious implications for prevention. Other implications for the prevention of cervical cancer are briefly discussed. © 1994 Wiley-Liss, Inc.     

Integrated approach to prediction of cervical intra‐epithelial neoplasia status through a case‐control study

A case‐control study on cervical intra‐epithelial neoplasia (CIN) was carried out on 398 subjects in the state of West Bengal, India. These samples were taken from mass screening programs organized by the authors, maintaining the uniformity of sampling to the extent possible. The cervical smears were tested by the Papanicolaou (PAP) method, following the Bethesda system for reporting of CIN status. Odds ratios and correlation coefficients among different variables, assumed to produce carcinoma of the cervix, show that 6 out of 11 variables, i.e., age, education, socio‐economic status, duration of marriage, age at marriage and body surface, are associated with CIN. Multivariate analysis of logistic regression was carried out using BMDP‐LR with dichotomized response variables considering CIN (0 and 1) in one group and CIN (2 and 3) in the other group. The outcome of the analysis indicated that age and educational level are 2 contributing factors for CIN. The percentage of correct classification in this analysis has improved to 74.5%, with a probability of 0.90. Polychotomous regression analysis was carried out using BMDP‐PR in the next step. This analysis showed that parity was a contributing factor, in addition to age and educational level. These 3 factors provide a predictive model for identifying the high‐risk group in a rational way. This approach would restrict screening to approximately 10% of the population. Subsequently, the model has been validated in a confirmatory trial among 85 new cases and was found to work satisfactorily. Int. J. Cancer (Pred. Oncol.) 84:69–73, 1999. © 1999 Wiley‐Liss, Inc.     

Risk factors for adenocarcinoma and squamous cell carcinoma of the cervix in women aged 20-44 years: the UK National Case-Control Study of Cervical Cancer

We report results on risk factors for invasive squamous cell and adenocarcinomas of the cervix in women aged 20-44 years from the UK National Case-Control Study of Cervical Cancer, including 180 women with adenocarcinoma, 391 women with squamous cell carcinoma and 923 population controls. The risk of both squamous cell and adenocarcinoma was strongly related to the lifetime number of sexual partners, and, independently, to age at first intercourse. The risk of both types of cervical cancer increased with increasing duration of use of oral contraceptives, and this effect was most marked in current and recent users of oral contraceptives. The risk of squamous cell carcinoma was associated with high parity and the risk of both squamous cell and adenocarcinoma increased with early age at first birth. Long duration smoking (20 or more years) was associated with a two-fold increase in the risk of squamous cell carcinoma, but smoking was not associated with the risk of adenocarcinoma. Further studies are needed to confirm the suggestion from this and other studies of differences in risk related to smoking between squamous cell and adenocarcinomas of the cervix.     

Current Status of Knowledge,Attitude and Practice (KAP) and Screening for Cervical Cancer in Countries at Different Levels of Development

Cancer of the uterine cervix is a worldwide menace taking innumerable womens’ lives. The literature is vastand a large number of studies have been conducted in this field. Analyses have shown significant differencesexist in terms of screening and HPV testing facilities among high income and low to middle income countries. Inaddition, acute lack of awareness and knowledge among the concerned population is particularly noted in ruralareas of the low income countries. A detailed review of Indian case studies revealed that early age of marriageand childbirth, multiparity, poor personal hygiene and low socio-economic status among others are the principalrisk factors for this disease. This review concludes that a two pronged strategy involving strong government andNGO action is necessary to minimize the occurrence of cervical cancer especially in low and medium incomecountries.     

A prospective study of the independent effects of parity and age at first birth on breast cancer incidence in England and Wales

The independent effects of parity and age at first birth on breast cancer incidence are investigated in a 1% sample of women aged 16 to 59 from the 1971 Census of England and Wales. Over the period 1971-81, 1,003 breast cancer cases occurred in the cohort of 113,263 women who were either married, widowed or divorced at the time of Census. Age at first birth was positively related to breast cancer risk, women giving birth to their first child after 35 years being at greater risk than nulliparous women. This effect remained, after adjustment for number of live-born children. Breast cancer risk showed a statistically significant decline with increasing parity even after adjustment for age at first birth. These results are consistent with other published evidence which suggests that other births subsequent to the first have an independent effect on breast cancer risk.     

Association between chronological change of reproductive factors and breast cancer risk defined by hormone receptor status: results from the Seoul Breast Cancer Study

Lifestyle factors have been chronologically changed into western style ones, which could result in the rapid increase of breast cancer incidence in Korea. It is plausible that reproductive factors through hormonal mechanisms are differentially related to the risk of breast cancer subtypes. We investigated the association of reproductive risk factors on breast cancer by birth year groups and also evaluated the differential associations on the hormone receptor-defined subtypes. Using the data from the Seoul Breast Cancer Study (SeBCS), a multicenter case–control study, 3,332 breast cancer patients and 3,620 control subjects were analyzed. The distribution of subtypes among cases was as follows: 61.0 % estrogen receptor (ER)-positive, 51.9 % progesterone receptor (PR)-positive, and 43.4 % both ER/PR-positive status, respectively. Polytomous logistic regression and Wald tests for heterogeneity have been used across the subtypes. The frequencies of reproductive-related risk factors including early age at menarche, nulligravid, age at first full-term pregnancy (FFTP), duration of estrogen exposure before FFTP (EEBF), less number of children, never breastfeeding, and short duration of breastfeeding has increased as women were born later in both cases and controls, respectively (p _trend < 0.0001. Among breast cancer patients, either ER- or PR-positive subtypes were increased in women born in 1960s compared to women born in 1940s. Early age at menarche increased the risk of breast cancer regardless of the subtypes while nulligravid, late age at FFTP, and longer duration of EEBP were associated with hormone receptor-positive cancer risk only (p _{heterogeneity} < 0.05), which associations were stronger among women born later. Our results suggest that the associations of age at menarche, parity, age at FFTP, and duration of EEBF with breast cancer risk were different based on the hormone receptor status and birth year groups in Korea.     

Evaluation of Cervical Cancer Risk-factors in Women referredto Yazd-Iran Hospitals from 2002 to 2009

Background: Although cervical cancer is a preventable disease, its prevalence is increasing in many developingcountries. The aim of this study was to evaluate risk factors. Materials and Methods: This cross-sectional studywas conducted on 100 cervical cancer cases according to their pathology reports in Yazd city. The patients werereferred to 4 gynecological centers. Demographic data (age, age at marriage, number of marriages and spouses,age at first pregnancy, frequency of pregnancies and term labors, positive history of smoking and Pap smearfindings were documented by interview, questionnaire and reviewing patients documents. The data were analyzedwith SPSS software. Results: Mean age of the patients was 53.6 years. Mean age of marriage and first pregnancywas 15.2 and 16.6; respectively. Twenty percent (20%) of the cases married more than once and husbands of 38patients (38%) had another wife too. Frequency of pregnancies and term labors was 7.4 and 6.4 in our patients.Some 17% of the patients had history of smoking; while 53% of them were passive smokers. Also only 2% ofour patients have done Pap smear before diagnosis. Discussion: The important risk factors of patients withcervical cancer were as follows: Marriage at young age (15.2%), high mean parity (7.4), low mean age at firstpregnancy (16.2 year), smoking, and not doing Pap smear. Conclusion: There is important association betweenmass screening program with Pap smear and decreasing cervical cancer. Thus we should increase our womenknowledge about all of risk-factors of cervical cancer and get them clues about regular pap smears.     

Duration of gestation and prostate cancer risk in offspring.

This large population-based nested case-control study investigated the importance of perinatal characteristics as risk factors for prostate cancer in later life in a cohort of men who were born between 1889 and 1941 in Stockholm, Sweden. Eight hundred and thirty-four prostate cancer cases over 18 years of age and of singleton birth were identified from the cohort between 1958 and 1994. For each case, singleton males born live to the first four mothers admitted after the case's mother were selected as potential controls; 1880 eligible controls were included in the study. For each study subject, we obtained data on mother's parity, pre-eclampsia or eclampsia before delivery, age at delivery, and socioeconomic status, as well as child's birth length and weight, placental weight, and gestational age. Odds ratio (OR) estimates and 95% confidence intervals (CIs) were derived from logistic regression analyses. We found no statistically significant differences between cases and controls with respect to maternal age, socioeconomic status, or parity. Birth weight, birth length, and placental weight were also not significantly related to prostate cancer risk. Pregnancy toxemia (OR = 0.33; 95% CI, 0.07-1.45) and longer gestation age were associated with a reduced risk of prostate cancer; the OR estimate was 0.94 (95% CI, 0.89-0.99) for each 1-week prolongation of the duration of gestation. Our results suggest that birth size indicators are not important risk factors for prostate cancer in later life. In addition, our data on gestation age indicate that the late in utero environment may be as important as the early in utero environment in the modulation of prostate cancer risk in offspring.     

Reproductive factors and cancers of the breast and genital organs--are the different cancer sites similarly affected?

Relationships between reproductive factors and cancer of the breast and genital organs were investigated in a prospective study of 63,090 Norwegian women. During followup from 1961 through 1980 1565 cases of breast cancer, 422 cases of cancer of the corpus uteri, and 471 cases of ovarian cancer were diagnosed. High parity was associated with low risk of cancer of the breast, corpus uteri, and ovary in analyses with adjustment for age at first birth. Age at first birth and age at last birth were positively associated with risk of breast cancer and inversely associated with endometrial cancer, whereas no clear associations were observed with ovarian cancer. Results suggest that the effect of a pregnancy on cancer risk is mediated, at least in part, by different mechanisms for these three sites. Age at menarche was inversely and age at menopause positively related to risk of breast and endometrial cancer, whereas no association was observed for ovarian cancer. In analyses of squamous cell carcinoma of the cervix uteri, an association with reproductive factors was expected from the known relationships with sexual habits. However, this cannot account for the high risk observed in this study in women with early age at first birth.