Abstract
Aside from human papillomavirus (HPV), the role of other risk factors in cervical cancer such as age, education, parity, sexual partners, smoking and human immunodeficiency virus (HIV) have been described but never ranked in order of priority. We evaluated the contribution of several known lifestyle co-risk factors for cervical cancer among black South African women. We used participant data from the Johannesburg Cancer Study, a case-control study of women recruited mainly at Charlotte Maxeke Johannesburg Academic Hospital between 1995 and 2016. A total of 3,450 women in the study had invasive cervical cancers, 95% of which were squamous cell carcinoma. Controls were 5,709 women with cancers unrelated to exposures of interest. Unconditional logistic regression models were used to calculate adjusted odds ratios (ORadj) and 95% confidence intervals (CI). We ranked these risk factors by their population attributable fractions (PAF), which take the local prevalence of exposure among the cases and risk into account. Cervical cancer in decreasing order of priority was associated with (1) being HIV positive (ORadj = 2.83, 95% CI = 2.53-3.14, PAF = 17.6%), (2) lower educational attainment (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 16.2%), (3) higher parity (3+ children vs 2-1 children (ORadj = 1.25, 95% CI = 1.07-1.46, PAF = 12.6%), (4) hormonal contraceptive use (ORadj = 1.48, 95% CI = 1.24-1.77, PAF = 8.9%), (5) heavy alcohol consumption (ORadj = 1.44, 95% CI = 1.15-1.81, PAF = 5.6%), (6) current smoking (ORadj = 1.64, 95% CI = 1.41-1.91, PAF = 5.1%), and (7) rural residence (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 4.4%). This rank order of risks could be used to target educational messaging and appropriate interventions for cervical cancer prevention in South African women.
Highlights
Cervical cancer is the fourth most frequently occurring cancer type and the fourth leading cause of death from cancer among women globally [1]
Cervical cancer was associated with being human immunodeficiency virus (HIV)-positive, educational attainment, higher parity, contraceptive use, heavy consumption of alcohol, current smoking and residing in rural areas among black South African women
Cervical cancer risk was significantly associated with HIV infection, which was ranked as the most important risk factor, with a population attributable fractions (PAF) of 17.6%
Summary
Cervical cancer is the fourth most frequently occurring cancer type and the fourth leading cause of death from cancer among women globally [1]. In sub-Saharan Africa (SSA), more than 101,423 new cases and 76,444 deaths of cervical cancer occur each year [1]. In South Africa, the age-standardised incidence rate of cervical cancer as reported by Globocan is 44.4 per 100,000 women per year [1]. According to the 2017 South African National Cancer Registry report, there were 5,630 new histologically confirmed cases of cervical cancer amongst black women with a lifetime risk (0–74 years) of 1 in 33 women [2]. At least 90% of women with hr-HPV infection, do not develop cervical cancer [3]. We evaluated the contribution of several known lifestyle co-risk factors for cervical cancer among black South African women
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