A population-based case-control study of cervical cancer was conducted in Spain and Colombia to assess the relationship between cervical cancer and exposure to human papillomavirus (HPV), selected aspects of sexual and reproductive behaviour, use of oral contraceptives, screening practices and smoking. The study included 436 cases of histologically confirmed squamous-cell carcinoma and 387 age-stratified controls randomly selected from the general population that generated the cases. The presence of HPV DNA in cervical scrapes was assessed by PCR-based methods and was the strongest risk factor (OR = 23.8; 13.4-42.0). Risk estimates for any other factor were only slightly modified after adjusting for HPV status. Among women found positive for HPV DNA, only the use of oral contraceptives was a risk factor for cervical cancer (OR = 6.5; 1.3-31.4 for ever vs. never use). Patients with cervical cancer who were HPV DNA-negative retained most of the established epidemiological features of this disease. This suggests that some instances of HPV infection went undetected or that other sexually transmitted factor(s) contribute to the causation of cervical cancer. Early age at first intercourse (OR = 4.3; 2.1-9.0 for age < 16 vs. 24+) and early age at first birth (OR = 5.0; 1.8-14.2 for age < 16 vs. 24+) were associated with increased risk of cervical cancer; these effects were independent of one another. Low educational level was a risk factor (OR = 2.5; 1.6-3.9). Number of sexual partners was in our study a surrogate for HPV infection. Smoking and parity after age 24 were weakly and inconsistently associated with the risk of cervical cancer. Previous screening (OR = 0.7; 0.5-1.0) and ever having undergone a Caesarean section (OR = 0.4; 0.2-0.8) were protective factors.
PIP: Findings are presented from a population-based case-control study of cervical cancer conducted in Spain and Colombia to assess the relationship between cervical cancer and exposure to human papillomavirus (HPV), selected aspects of sexual and reproductive behavior, the use of oral contraceptives, screening practices, and smoking. 436 cases of histologically confirmed squamous-cell carcinoma and 387 age-stratified controls randomly selected from the general population which generated the cases participated in the study. Cases in Colombia were of mean age 46.5 years compared to 52.2 years in Spain. The presence of HPV DNA in cervical scrapes was assessed by PCR-based methods and was the most significant risk factor, with at least 70% of cervical cancer cases associated with the viral infection. Risk estimates for other factors were only slightly modified after adjusting for HPV status. Among women found positive for HPV DNA, only the use of oral contraceptives was a risk factor for cervical cancer, with patients with cervical cancer who were HPV DNA-negative retaining most of the established epidemiological features of the disease. This latter finding suggests that some cases of HPV infection were undetected or that other sexually transmitted factors contribute to the causation of cervical cancer. Early age at first intercourse and early age at first birth were independently associated with an increased risk of cervical cancer. Low educational level was a risk factor and the number of sex partners was a surrogate for HPV infection. Smoking and parity after age 24 were weakly and inconsistently associated with the risk of cervical cancer. Previous screening and ever having undergone a Caesarean section were protective factors.