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Differences in the risk of cervical cancer and human papillomavirus infection by education level.

Franceschi S, Plummer M, Clifford G, de Sanjose S, Bosch X, Herrero R, Muñoz N, Vaccarella S, International Agency for Research on Cancer Multicentric Cervical Cancer Study GroupsInternational Agency for Research on Cancer Human Papillomavirus Prevalence Surveys Study Gro - Br. J. Cancer (2009)

Bottom Line: In contrast, no association emerged between education level and HPV infection in either of the two IARC studies.Parity and screening history (but not lifetime number of sexual partners, husband's extramarital sexual relationships, and smoking) also seemed to be important confounding factors.The excess of cervical cancer found in women with a low socio-economic status seems, therefore, not to be explained by a concomitant excess of HPV prevalence, but rather by early events in a woman's sexually active life that may modify the cancer-causing potential of HPV infection.

View Article: PubMed Central - PubMed

Affiliation: International Agency for Research on Cancer, 69372 Lyon cedex 08, France. franceschi@iarc.fr

ABSTRACT

Background: Cervical cancer risk is associated with low education even in an unscreened population, but it is not clear whether human papillomavirus (HPV) infection follows the same pattern.

Methods: Two large multicentric studies (case-control studies of cervical cancer and HPV prevalence survey) including nearly 20 000 women. GP5+/GP6+ PCR was used to detect HPV.

Results: Education level was consistently associated with cervical cancer risk (odds ratio (OR) for 0 and >5 years vs 1-5 years=1.50, 95% confidence interval (CI): 1.25-1.80 and 0.69, 95% CI: 0.57-0.82, respectively, P for trend <0.0001). In contrast, no association emerged between education level and HPV infection in either of the two IARC studies. A majority of the women studied had never had a Pap smear. The association between low education level and cervical cancer was most strongly attenuated by adjustment for age at first sexual intercourse and first pregnancy. Parity and screening history (but not lifetime number of sexual partners, husband's extramarital sexual relationships, and smoking) also seemed to be important confounding factors.

Conclusion: The excess of cervical cancer found in women with a low socio-economic status seems, therefore, not to be explained by a concomitant excess of HPV prevalence, but rather by early events in a woman's sexually active life that may modify the cancer-causing potential of HPV infection.

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Odds ratios (OR)† and corresponding 95% confidence intervals (CI) for human papillomavirus (HPV) positivity by education level. The International Agency for Research on Cancer HPV Prevalence Surveys. FSE=floating standard error. †Adjusted for age, study area, lifetime number of sexual partners, age at first sexual intercourse, husbands' extramarital sexual relationships and history of Pap smear.
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fig3: Odds ratios (OR)† and corresponding 95% confidence intervals (CI) for human papillomavirus (HPV) positivity by education level. The International Agency for Research on Cancer HPV Prevalence Surveys. FSE=floating standard error. †Adjusted for age, study area, lifetime number of sexual partners, age at first sexual intercourse, husbands' extramarital sexual relationships and history of Pap smear.

Mentions: In agreement with the findings among control women in the case–control studies, no association between education level and HPV positivity was found among the larger number of women included in the prevalence surveys (OR for >10, 1–5, and 0 years vs 6–10 years=1.03, 95% CI: 0.90–1.18; 0.88, 95% CI: 0.76–1.02; and 1.06, 95% CI: 0.87–1.28, respectively, P for trend=0.67) (Figure 3). Although some differences emerged across study areas with some non-statistically significant associations in either direction, no significant heterogeneity was found between study areas with respect to HPV infection and education level.


Differences in the risk of cervical cancer and human papillomavirus infection by education level.

Franceschi S, Plummer M, Clifford G, de Sanjose S, Bosch X, Herrero R, Muñoz N, Vaccarella S, International Agency for Research on Cancer Multicentric Cervical Cancer Study GroupsInternational Agency for Research on Cancer Human Papillomavirus Prevalence Surveys Study Gro - Br. J. Cancer (2009)

Odds ratios (OR)† and corresponding 95% confidence intervals (CI) for human papillomavirus (HPV) positivity by education level. The International Agency for Research on Cancer HPV Prevalence Surveys. FSE=floating standard error. †Adjusted for age, study area, lifetime number of sexual partners, age at first sexual intercourse, husbands' extramarital sexual relationships and history of Pap smear.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2736843&req=5

fig3: Odds ratios (OR)† and corresponding 95% confidence intervals (CI) for human papillomavirus (HPV) positivity by education level. The International Agency for Research on Cancer HPV Prevalence Surveys. FSE=floating standard error. †Adjusted for age, study area, lifetime number of sexual partners, age at first sexual intercourse, husbands' extramarital sexual relationships and history of Pap smear.
Mentions: In agreement with the findings among control women in the case–control studies, no association between education level and HPV positivity was found among the larger number of women included in the prevalence surveys (OR for >10, 1–5, and 0 years vs 6–10 years=1.03, 95% CI: 0.90–1.18; 0.88, 95% CI: 0.76–1.02; and 1.06, 95% CI: 0.87–1.28, respectively, P for trend=0.67) (Figure 3). Although some differences emerged across study areas with some non-statistically significant associations in either direction, no significant heterogeneity was found between study areas with respect to HPV infection and education level.

Bottom Line: In contrast, no association emerged between education level and HPV infection in either of the two IARC studies.Parity and screening history (but not lifetime number of sexual partners, husband's extramarital sexual relationships, and smoking) also seemed to be important confounding factors.The excess of cervical cancer found in women with a low socio-economic status seems, therefore, not to be explained by a concomitant excess of HPV prevalence, but rather by early events in a woman's sexually active life that may modify the cancer-causing potential of HPV infection.

View Article: PubMed Central - PubMed

Affiliation: International Agency for Research on Cancer, 69372 Lyon cedex 08, France. franceschi@iarc.fr

ABSTRACT

Background: Cervical cancer risk is associated with low education even in an unscreened population, but it is not clear whether human papillomavirus (HPV) infection follows the same pattern.

Methods: Two large multicentric studies (case-control studies of cervical cancer and HPV prevalence survey) including nearly 20 000 women. GP5+/GP6+ PCR was used to detect HPV.

Results: Education level was consistently associated with cervical cancer risk (odds ratio (OR) for 0 and >5 years vs 1-5 years=1.50, 95% confidence interval (CI): 1.25-1.80 and 0.69, 95% CI: 0.57-0.82, respectively, P for trend <0.0001). In contrast, no association emerged between education level and HPV infection in either of the two IARC studies. A majority of the women studied had never had a Pap smear. The association between low education level and cervical cancer was most strongly attenuated by adjustment for age at first sexual intercourse and first pregnancy. Parity and screening history (but not lifetime number of sexual partners, husband's extramarital sexual relationships, and smoking) also seemed to be important confounding factors.

Conclusion: The excess of cervical cancer found in women with a low socio-economic status seems, therefore, not to be explained by a concomitant excess of HPV prevalence, but rather by early events in a woman's sexually active life that may modify the cancer-causing potential of HPV infection.

Show MeSH
Related in: MedlinePlus