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Title: The Influence of Hormonal Factors on the Risk of Developing Cervical Cancer and Pre-Cancer: Results from the EPIC Cohort
Author: Roura, Esther
Travier, Noémie
Waterboer, Tim
Sanjosé Llongueras, Silvia de
Bosch José, Francesc Xavier, 1947-
Pawlita, Michael
Pala, Valeria
Weiderpass, Elisabete
Margall, Núria
Dillner, Joakim
Gram, Inger T.
Tjønneland, Anne
Munk, Christian
Palli, Domenico
Khaw, Kay-Tee
Overvad, Kim
Clavel-Chapelon, Françoise
Mesrine, Sylvie
Fournier, Agnès
Fortner, Renée T.
Ose, Jennifer
Steffen, Annika
Trichopoulou, Antonia
Lagiou, Pagona
Orfanos, Philippos
Masala, Giovanna
Tumino, Rosario
Sacerdote, Carlotta
Polidoro, Silvia
Mattiello, Amalia
Lund, Eiliv
Peeters, Petra H. M.
Bueno de Mesquita, H. Bas
Quirós, J. Ramón
Sanchez, María José
Navarro, Carmen
Barricarte, Aurelio
Larrañaga, Nerea
Ekström, Johanna
Lindquist, David
Idahl, Annika
Travis, Ruth C.
Merritt, Melissa A.
Gunter, Marc J.
Rinaldi, Sabina
Tommasino, Massimo
Franceschi, Silvia
Riboli, Elio
Castellsagué, Xavier
Keywords: Càncer de coll uterí
Cervix cancer
Issue Date: 25-Jan-2016
Publisher: Public Library of Science (PLoS)
Abstract: Background: In addition to HPV, high parity and hormonal contraceptives have been associated with cervical cancer (CC). However, most of the evidence comes from retrospective case-control studies. The aim of this study is to prospectively evaluate associations between hormonal factors and risk of developing cervical intraepithelial neoplasia grade 3 (CIN3)/carcinoma in situ (CIS) and invasive cervical cancer (ICC). Methods and Findings: We followed a cohort of 308,036 women recruited in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study. At enrollment, participants completed a questionnaire and provided serum. After a 9-year median follow-up, 261 ICC and 804 CIN3/CIS cases were reported. In a nested case-control study, the sera from 609 cases and 1,218 matched controls were tested for L1 antibodies against HPV types 11,16,18,31,33,35,45, 52,58, and antibodies against Chlamydia trachomatis and Human herpesvirus 2. Multivariate analyses were performed to estimate hazard ratios (HR), odds ratios (OR) and corresponding 95% confidence intervals (CI). The cohort analysis showed that number of fullterm pregnancies was positively associated with CIN3/CIS risk (p-trend = 0.03). Duration of oral contraceptives use was associated with a significantly increased risk of both CIN3/CIS and ICC (HR = 1.6 and HR = 1.8 respectively for >= 15 years versus never use). Ever use of menopausal hormone therapy was associated with a reduced risk of ICC (HR = 0.5, 95% CI: 0.4-0.8). A non-significant reduced risk of ICC with ever use of intrauterine devices (IUD) was found in the nested case-control analysis (OR = 0.6). Analyses restricted to all cases and HPV seropositive controls yielded similar results, revealing a significant inverse association with IUD for combined CIN3/CIS and ICC (OR = 0.7). Conclusions: Even though HPV is the necessary cause of CC, our results suggest that several hormonal factors are risk factors for cervical carcinogenesis. Adherence to current cervical cancer screening guidelines should minimize the increased risk of CC associated with these hormonal risk factors.
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It is part of: PLoS One, 2016, vol. 11, num. 1, p. e0147029
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Appears in Collections:Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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