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American Journal of Epidemiology Vol. 140, No. 8: 700-710
Copyright © 1994 by The Johns Hopkins University School of Hygiene and Public Health

research-article

Risk Factors for Cervical Intraepithelial Neoplasia: Differences between Low- and High-grade Lesions

Jacques Brisson1,, Carol Morin2, Michel Fortier3, Michel Roy3,4, Céline Bouchard3, Jules Leclerc3, Andrée Christen1, Chantal Guimont1, Frédérique Penault2 and Alexandre Meisels2

1Laval University Epidemiology Research Group, Department of Social and Preventive Medicine, Laval University Quebec, Quebec, Canada
2Department of Pathology, Hôpital du Saint Sacrement Quebec, Quebec, Canada
3Colposcopy Clinic and Department of Obstetrics and Gynaecology, Hôpital du Saint-Sacrement Quebec, Quebec, Canada
4Department of Gynecology, Hotel-Dieu de Québec Quebec, Quebec, Canada

Reprint requests to Dr. Jacques Brisson, Epidemiology Research Unit, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Quebec, Quebec, Canada G1S 4L8

This case-control study assesses relations of human papillomavirus (HPV) type 16 infection, sexual history, cigarette smoking, and oral contraceptive use to low- and high-grade cervical intraepithelial neoplasia (CIN). A total of 548 high-grade and 338 low-grade CIN cases and 612 controls were identified among women seen at a colposcopy clinic in Quebec, Quebec, Canada, in 1988–1989. Interviews, colposcopy, cervical scrapings, and colposcopically directed biopsies were performed. One pathologist reviewed all histologic slides. Southern blot techniques were used to assay specimens for HPV 16 DNA. Lifetime number of sexual partners was related to low- and high-grade CIN. Presence of HPV 16 DNA was associated with a 8.7-fold (95% confidence interval 5.1–15.0) elevation in estimated relative risk of high-grade CIN. Relative risk of high-grade CIN increased with amount of HPV 16 DNA (p < 0.0001). Estimated relative risk of high-grade CIN in current cigarette smokers was 2.4 (95% confidence interval 1.8–3.2) compared with never smokers and increased with number of pack-years of exposure (p < 0.0001). Long-term (6 years or more) users of oral contraceptives had an estimated relative risk of high-grade CIN of 1.9 (95% confidence interval 1.1–3.3) compared with those who never used such contraceptives. In contrast, presence of HPV 16 DNA, cigarette smoking, and oral contraceptive use showed little or no relation to low-grade CIN. Risk factors for low- and high-grade CIN may differ substantially.

cervix neoplasms; contraception; Papillomaviruses; smoking


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