The effect of exogenous hormones, smoking and HPV on the incidence of screen detected pre-invasive cervical cancer.

宫颈癌是全球妇女癌症死亡的主要原因之一。新南威尔士州每年约有15,000名妇女被检测出患有侵袭前宫颈癌（宫颈上皮内瘤变（CIN） I级、II级或III级）。感染某些高风险的人乳头瘤病毒是患上子宫颈癌的必要条件。此外，近期长期吸烟和激素避孕是被认为是该疾病独立危险因素的两个新因素。更年期前后服用的激素替代疗法（HRT）制剂与激素避孕药（雌激素和孕激素）的成分相似，因此接受HRT治疗的女性也可能面临更高的风险。国际上尚无综合性研究以与公共卫生相关的方式衡量这些外源性激素对侵袭前宫颈癌发展的相对重要性（例如，近期长期使用口服避孕药和停止使用后的时间，以及在吸烟者和非吸烟者之间）。澳大利亚没有关于目前使用激素避孕药或激素替代疗法的妇女比例的数据。澳大利亚没有关于主要高危HPV亚型（例如16、18、33、45）的当地流行率数据，无法描述其分布情况，也无法为子宫颈筛查规划和未来的疫苗举措提供信息。新南威尔士州巴氏试验登记记录了所有宫颈筛查项目中妇女的筛查历史，因此这是招募有代表性样本进行研究的理想来源。我们希望对2600名新南威尔士州妇女进行一项大型研究，使用新南威尔士州巴氏试验登记来衡量激素、吸烟和HPV感染对CIN II或III发展的相对重要性。

Cervical cancer is one of the leading causes of cancer death in women internationally. About 15,000 women are detected in NSW annually as having pre-invasive cervical cancer (cervical intraepithelial neoplasia (CIN) grade I, II or III). Infection with certain high risk human papillomaviruses is known to be necessary for the development of cervical cancer. In addition, recent long term exposure to smoking and to hormonal contraception are two new factors considered as independent risk factors for the disease. Hormone replacement therapy (HRT) preparations taken around the menopause are a similar composition to hormonal contraceptives, (oestrogen and progestogen), therefore women on HRT may also be at increased risk. No comprehensive study exists internationally to measure the relative importance of these exogenous hormones on the development of pre-invasive cervical cancer in a way that is of public health relevance (e.g. recent long-term use of oral contraceptives and time since stopped, and among smokers and non-smokers). No Australian data are available on the proportion of women who are current users of hormonal contraceptives or HRT. No local prevalence data on the major high risk HPV subtypes (e.g. 16, 18, 33, 45) are available for Australia to describe its distribution and to inform the cervical screening program and future vaccine initiatives. The NSW Pap Test Register holds the screening history of all women on the cervical screening program, hence this is an ideal source for recruiting a representative sample into a study. We wish to conduct a large study of ~2600 NSW women using the NSW Pap Test Register to measure the relative importance of hormones, smoking and HPV infection on the development of CIN II or III.