Factors associated with the risk of progression to precursor lesions or cervical cancer in women with negative cytologic findings
Received 19 May 2009; received in revised form 26 June 2009; accepted 27 July 2009. published online 01 September 2009.
Abstract
Objective
To evaluate factors associated with progression to cervical cancer or moderate to severe precursor lesions (cervical intraepithelial neoplasia grade 2 [CIN 2] or higher) in women with negative cervical screening results.
Method
A cohort of 1236 women from the state of Rio de Janeiro, Brazil, was followed up for 36months. Hazards ratios (HR) and related 95% confidence intervals (CIs) were calculated, and the Cox proportional hazards model was used to evaluate factors associated with the development of lesions grade CIN 2 or higher.
Results
After adjusting for age, education level, number of sexual partners, and parity, the presence of CIN 2 or more advanced lesions was associated with HPV infection (HR, 39.0; 95% CI, 9.8–156.0), smoking (HR, 7.7; 95% CI, 2.0–29.6), and early age at first sexual intercourse (HR, 4.1; 95% CI, 1.1–15.1).
Conclusion
These findings suggest that women at increased risk for cervical cancer be screened for HPV at the time of cervical screening, particularly in areas where access to health services is difficult. Antismoking strategies especially targeting young women should be a priority in a comprehensive women's health care program.
aInstitute for Social Medicine (IMS), Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
bUniversidade Federal do Estado do Rio de Janeiro (UNIRIO) and Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
Corresponding author. Institudo de Mrdicina Social (IMS), Universitade Estadual do Rio de Janeiro (UERJ), Rua São Francisco Xavier 524, pavilhão João lira Filho, D7022, Maracanã, CEP: 20 550–900, Rio de Janeiro, RJ, Brazil. Fax: +55 21 22 64 11 42.
ABSTRACT