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American Journal of Epidemiology Advance Access published online on December 13, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn354
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

Is Smoking an Independent Risk Factor for Invasive Cervical Cancer? A Nested Case-Control Study Within Nordic Biobanks

Aline Simen Kapeu, Tapio Luostarinen, Egil Jellum, Joakim Dillner, Matti Hakama, Pentti Koskela, Per Lenner, Arthur Löve, Eija Mahlamaki, Steinar Thoresen, Laufey Tryggvadóttir, Göran Wadell, Linda Youngman and Matti Lehtinen

Correspondence to Dr. Aline Simen Kapeu, National Public Health Institute, P.O. Box 310, 90101 Oulu, Finland (e-mail: kapeu_aline{at}yahoo.fr).

Received for publication April 18, 2008. Accepted for publication October 8, 2008.

The strong correlation between smoking and exposure to oncogenic human papillomaviruses (HPVs) has made it difficult to verify the independent role of smoking in cervical carcinogenesis. Thus, the authors evaluated this role. Five large Nordic serum banks containing samples from more than 1,000,000 subjects were linked with nationwide cancer registries (1973–2003). Serum samples were retrieved from 588 women who developed invasive cervical cancer and 2,861 matched controls. The samples were analyzed for cotinine (a biomarker of tobacco exposure) and antibodies to HPV types 16 and 18, herpes simplex virus type 2, and Chlamydia trachomatis. Smoking was associated with the risk of squamous cell carcinoma (SCC) among HPV16- and/or HPV18-seropositive heavy smokers (odds ratio = 2.7, 95% confidence interval: 1.7, 4.3). A similar risk of SCC (odds ratio = 3.2, 95% confidence interval: 2.6, 4.0) was found in heavy smokers after adjustment for HPV16/18 antibodies. The point estimates increased with increasing age at diagnosis and increasing cotinine level. This study confirms that smoking is an independent risk factor for cervical cancer/SCC in women infected with oncogenic HPVs. These findings emphasize the importance of cervical cancer prevention among women exposed to tobacco smoke.

carcinoma, squamous cell; risk factors; smoking; uterine cervical neoplasms

Abbreviations: CI, confidence interval; HPV, human papillomavirus; MONICA, Monitoring of Trends and Determinants in Cardiovascular Disease; SCC, squamous cell carcinoma


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