Risk factors for rapid-onset cervical cancer
Risk factors for rapid-onset cervical cancer
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DOI：
10.1016/s0002-9378(99)70256-5
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发表时间：
1999-03-01
影响因子：
9.8
通讯作者：
Schiffman, M
中科院分区：
文献类型：
--
作者：
Hildesheim, A;Hadjimichael, O;Schiffman, M
目的：本研究旨在阐明在常规巴氏涂片筛查过程中与宫颈癌发展相关的危险因素（快发性宫颈癌）。研究设计：研究了483名诊断为浸润性宫颈癌的妇女，占1985年至1990年间康涅狄格州诊断出的所有此类肿瘤的73%。通过问卷调查和医生记录回顾获得巴氏涂片筛查和危险因素信息。采用聚合酶链反应法对278名研究对象进行了人乳头瘤病毒脱氧核糖核酸检测。对有筛查史的67%的病例复查了诊断前巴氏涂片。使用筛查史信息、幻灯片回顾和问卷调查数据将妇女分为快发性宫颈癌（n = 43）、可能快发性宫颈癌（n = 111）和正常发性宫颈癌（n = 329）。结果：与正常起病患者相比，快速起病患者倾向于年轻化（P= 0.001）、白人（P= 0.002）、诊断为腺癌或腺鳞癌（P= 0.001）、诊断为早期病变（P= 0.001）。诊断为可能是快速发病的病例往往具有与观察到的远快速发病和正常发病病例中间的特征。75.2%的病例检出人乳头瘤病毒脱氧核糖核酸。与16型人乳头瘤病毒或其他病毒检测呈阳性的妇女相比，18型人乳头瘤病毒检测呈阳性的妇女患速发性疾病的相对风险为1.6（95%可信区间0.52-4.9）。当可能的快速发病病例与诊断为正常发病宫颈癌的妇女进行比较时，未观察到18型与可能的快速发病疾病之间的显著关联（相对危险度0.67,95%可信区间0.29-1.6）。口服避孕药的使用、吸烟、怀孕次数和产妇宫颈癌史与快速发病无显著相关性。结论：本研究结果提示，与快速起病宫颈癌发生相关的危险因素与正常起病的危险因素相似。
OBJECTIVES: The current study was designed to elucidate risk factors associated with the development of cervical cancer during the course of routine Papanicolaou smear screening (rapid-onset cervical cancer).STUDY DESIGN: Four hundred eighty-three women diagnosed with invasive cervical cancer, representing 73% of all such tumors diagnosed in Connecticut between 1985 and 1990, were studied. Papanicolaou smear screening and risk factor information was obtained by questionnaire and physician record review. Results from human papillomavirus deoxyribonucleic acid testing by polymerase chain reaction of tumor samples were available for 278 study participants. Prediagnostic Papanicolaou smear slides were reviewed for 67% of cases with a screening history. Screening history information, slide review, and questionnaire data were used to classify women as having rapid-onset cervical cancer (n = 43), possible rapid-onset cervical cancer (n = 111), or normal-onset cervical cancer (n = 329).RESULTS: Compared with normal-onset cases, rapid-onset cases tended to be younger (P =.001) and were more likely to be white (P=.002), diagnosed with adenocarcinomas or adenosquamous carcinomas (P=.001), and diagnosed with early-stage disease (P=.001). Cases diagnosed as possible rapid-onset disease tended to have a profile that was intermediate to that observed far rapid-onset and normal-onset cases. Human papillomavirus deoxyribonucleic acid was detected in 75.2% of cases tested. Compared with women who tested positive for human papillomavirus type 16 or other, those positive for human papillomavirus type 18 had a relative risk for rapid-onset disease of 1.6 (95% confidence interval 0.52-4.9). No significant association was observed between type 18 and possible rapid-onset disease when possible rapid-onset cases were compared with women diagnosed with normal-onset cervical cancer (relative risk 0.67, 95% confidence interval 0.29-1.6). Oral contraceptive use, cigarette smoking, number of pregnancies, and a maternal history of cervical cancer were not significantly associated with rapid-onset disease.CONCLUSIONS: Results from this study suggest that the risk factors associated with the development of rapidonset cervical cancer are similar to those for normal-onset disease.