This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McIntyre-Seltman, K. Search for Related Content PubMed PubMed Citation Articles by McIntyre-Seltman, K.

Smoking Is a Risk Factor for Cervical Intraepithelial Neoplasia Grade 3 among Oncogenic Human Papillomavirus DNA–Positive Women with Equivocal or Mildly Abnormal Cytology

¹ Magee-Womens Hospital of the University of Pittsburgh Health Care System, Pittsburgh, Pennsylvania; ² Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland; and ³ Departments of Molecular Genetics and Microbiology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, School of Medicine, Albuquerque, New Mexico

Requests for reprints: Philip E. Castle, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Room 7074, 6120 Executive Boulevard, EPS MSC 7234, Bethesda, MD 20892-7234. Phone: 301-435-3976; Fax: 301-402-091. E-mail: castlep{at}mail.nih.gov

Background: Smoking is a potential risk factor for cervical cancer and its immediate precursor, cervical intraepithelial neoplasia grade 3 (CIN3), but few studies have adequately taken into account the possible confounding effect of oncogenic human papillomavirus (HPV) infection.

Methods: Women (n = 5,060) with minimally abnormal Papanicolaou smears were enrolled in the ASCUS and LSIL Triage Study, a clinical trial to evaluate management strategies, and were seen every 6 months for the 2-year duration of the study. Cervical specimens were tested for HPV DNA using both Hybrid Capture 2 and PGMY09/11 L1 consensus primer PCR with reverse line blot hybridization for genotyping. Multivariate logistics regression models were used to assess associations [odds ratio (OR) with 95% confidence intervals (95% CI)] between smoking behaviors and rigorously reviewed cases of cervical intraepithelial neoplasia grade 3 or cancer (CIN3) identified throughout the study (n = 506) in women with oncogenic HPV (n = 3,133).

Results: Current smoking was only weakly associated with increased HPV infection. Among infected women, current smokers (OR, 1.7; 95% CI, 1.4-2.1) and past smokers (OR, 1.7; 95% CI, 1.2-2.4) were more likely to be diagnosed with CIN3 than nonsmokers. Greater smoking intensity (P_Trend < 0.0005) and duration (P_Trend < 0.0005) increased the strength of the association, with smoking 2 packs/d (OR, 3.3; 95% CI, 1.5-7.5) and smoking for 11 years (OR, 2.1; 95% CI, 1.5-2.9) most strongly associated with CIN3 as compared to non-smokers. The effects of intensity and duration seemed additive.

Conclusions: Women with oncogenic HPV and minimally abnormal Papanicolaou smears who smoke were up to three times more likely to be diagnosed with CIN3 than nonsmokers. Smoking cessation trials targeting this population might be warranted.

This article has been cited by other articles:

				K. Syrjanen, I. Shabalova, N. Petrovichev, V. Kozachenko, T. Zakharova, J. Pajanidi, J. Podistov, G. Chemeris, L. Sozaeva, E. Lipova, et al. Age at menarche is not an independent risk factor for high-risk human papillomavirus infections and cervical intraepithelial neoplasia Int J STD AIDS, January 1, 2008; 19(1): 16 - 25. [Abstract] [Full Text] [PDF]

				A. S. Gunnell, T. N. Tran, A. Torrang, P. W. Dickman, P. Sparen, J. Palmgren, and N. Ylitalo Synergy between Cigarette Smoking and Human Papillomavirus Type 16 in Cervical Cancer In situ Development Cancer Epidemiol. Biomarkers Prev., November 1, 2006; 15(11): 2141 - 2147. [Abstract] [Full Text] [PDF]

				G. F. Sawaya A 21-Year-Old Woman With Atypical Squamous Cells of Undetermined Significance JAMA, November 2, 2005; 294(17): 2210 - 2218. [Full Text] [PDF]