Abstract
PurposeWe investigated the association between alcohol consumption and risk of cervical intraepithelial neoplasia (CIN) and cervical cancer, and determined whether these associations were modified by human papillomavirus (HPV) viral load in high-risk HPV-positive women participating in the Korean HPV cohort study (KHPV).MethodsAmong the women recruited in the KHPV (n = 1,243) from March 2006 to December 2009, we analyzed normal cytology (n = 581) as control group, CIN1 (n = 299), CIN2/3 (n = 161), or cervical cancer (n = 202). Multinomial logistic analysis was performed to estimate multivariate-adjusted odds ratios (OR).ResultsAlcohol drinkers had an increased risk of CIN1 (OR = 2.18, 95% CI 1.22–3.89) compared with non-drinkers after adjusting for potential confounders. Subjects with more frequent alcohol consumption had a higher risk of CIN1 (p for linear trend <0.0001). Higher ethanol consumption was associated with an increased risk of CIN1 (p for linear trend = 0.0001). We also observed a synergistic effect between HPV viral load and alcohol consumption: drinkers with a high HPV viral load (≥100 RLU/PC) were associated with a significantly increased risk of CIN1 (OR = 19.1; 95% CI, 6.60–55.3, interaction p<0.001). There were no associations between alcohol drinking and CIN2/3 or cervical cancer.ConclusionsHPV viral load and alcohol was associated with the risk of CIN1 among high-risk HPV-positive women. This is the first demonstration that alcohol is an independent and combined risk factor of CIN1.
Highlights
Human papillomavirus (HPV) infection is one of the major causes of cervical intraepithelial neoplasia (CIN) and cervical cancer, most human papillomavirus (HPV) infections are asymptomatic and transient and other cofactors in conjunction with HPV infection are necessary for progression to malignant disease [1]
Neither CIN 2/3 nor cervical cancer showed an association with alcohol drinking
Compared with non-drinkers, drinkers with a high frequency and large amount of alcohol consumption had an increased risk of CIN1 (OR = 2.18, 95% confidence intervals (CIs): 1.22–3.89) after adjusting for potential confounders
Summary
Human papillomavirus (HPV) infection is one of the major causes of cervical intraepithelial neoplasia (CIN) and cervical cancer, most HPV infections are asymptomatic and transient and other cofactors in conjunction with HPV infection are necessary for progression to malignant disease [1]. The potential role of alcohol consumption in the etiology of cervical cancer has not been extensively studied [2]. The International Agency for Research on Cancer of the World Health Organization has classified alcohol as a Group 1 carcinogen [3]. High intake of alcohol increases the risk of cancer in multiple organs, including upper gastrointestinal tract, lung, liver, large bowel, and breast [4,5,6,7]. The relationship between alcohol and cancer remains controversial depending on the site of the malignancy
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