Abstract
Abstract High-risk human papillomavirus (HPV) types cause most cervical carcinomas and are sexually transmitted. Sexual behavior therefore affects HPV exposure and its cancer sequelae. The International Collaboration of Epidemiological Studies of Cervical Cancer has combined data on lifetime number of sexual partners and age at first sexual intercourse from 21 studies, or groups of studies, including 10,773 women with invasive cervical carcinoma, 4,688 women with cervical intraepithelial neoplasia grade 3 (CIN3)/carcinoma in situ, and 29,164 women without cervical carcinoma. Relative risks for invasive cancer and CIN3 were estimated by conditional logistic regression. Risk of invasive cervical carcinoma increased with lifetime number of sexual partners (P for linear trend <0.001). The relative risk for ≥6 versus 1 partner, conditioned on age, study, and age at first intercourse, was 2.27 [95% confidence interval (95% CI), 1.98-2.61] and increased to 2.78 (95% CI, 2.22-3.47) after additional conditioning on reproductive factors. The risk of invasive cervical carcinoma increased with earlier age at first intercourse (P for linear trend <0.001). The relative risk for age at first intercourse ≤14 versus ≥25 years, conditioned on age, study, and lifetime number of sexual partners was 3.52 (95% CI, 3.04-4.08), which decreased to 2.05 (95% CI, 1.54-2.73) after additional conditioning on reproductive factors. CIN3/carcinoma in situ showed a similar association with lifetime number of sexual partners; however, the association with age at first intercourse was weaker than for invasive carcinoma. Results should be interpreted with caution given the strong correlation between sexual and reproductive factors and the limited information on HPV status. (Cancer Epidemiol Biomarkers Prev 2009;18(4):1060–9)
Highlights
The association of cervical carcinoma with sexually transmitted infection has long been suggested by demographic and epidemiologic data [1, 2]
The proportion reporting z2 sexual partners ranged between 1% and 94% and the median age at first intercourse varied between 15 and 23 years
This collaborative reanalysis of individual data from more than 15,000 women with invasive cervical carcinoma (ICC) or cervical intraepithelial neoplasia grade 3 (CIN3)/carcinoma in situ confirms the relationship between major indicators of sexual behavior and the risk of cervical carcinoma
Summary
The association of cervical carcinoma with sexually transmitted infection has long been suggested by demographic and epidemiologic data [1, 2]. High-risk types of human papillomavirus (HPV), which are sexually transmitted, were first associated with cervical carcinoma (95% CI), 1.98-2.61] and increased to 2.78 (95% CI, 2.223.47) after additional conditioning on reproductive factors. The risk of invasive cervical carcinoma increased with earlier age at first intercourse (P for linear trend
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