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      Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries

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          Abstract

          Early age at first sexual intercourse (AFSI) has long been associated with an increased risk of invasive cervical carcinoma (ICC). Age at first pregnancy (AFP) and ICC have been investigated less, although AFSI and AFP are strongly interrelated in most developing countries. A pooled analysis of case–control studies on ICC from eight developing countries with 1864 cases and 1719 controls investigated the roles of AFSI, AFP, and ICC risk. Age at first sexual intercourse, AFP and age at first marriage (AFM) were highly interrelated and had similar ICC risk estimates. Compared with women with AFSI ⩾21 years, the odds ratio (OR) of ICC was 1.80 (95% CI: 1.50–2.39) among women with AFSI 17–20 years and 2.31 (95% CI: 1.85–2.87) for AFSI ⩽16 years ( P-trend <0.001). No statistical interaction was detected between AFSI and any established risk factors for ICC. The ICC risk was 2.4-fold among those who reported AFSI and AFP at ⩽16 years compared with those with AFSI and AFP at ⩾21 years. These data confirm AFSI and AFB as risk factors for ICC in eight developing countries, but any independent effects of these two events could not be distinguished.

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          The causal relation between human papillomavirus and cervical cancer.

          F X Bosch, A Lorincz, N Muñoz … (2002)
          The causal role of human papillomavirus infections in cervical cancer has been documented beyond reasonable doubt. The association is present in virtually all cervical cancer cases worldwide. It is the right time for medical societies and public health regulators to consider this evidence and to define its preventive and clinical implications. A comprehensive review of key studies and results is presented.
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            Sexual behaviour in context: a global perspective.

            Kaye Wellings, Martine Collumbien, Emma Slaymaker … (2006)
            Research aimed at investigating sexual behaviour and assessing interventions to improve sexual health has increased in recent decades. The resulting data, despite regional differences in quantity and quality, provide a historically unique opportunity to describe patterns of sexual behaviour and their implications for attempts to protect sexual health at the beginning of the 21st century. In this paper we present original analyses of sexual behaviour data from 59 countries for which they were available. The data show substantial diversity in sexual behaviour by region and sex. No universal trend towards earlier sexual intercourse has occurred, but the shift towards later marriage in most countries has led to an increase in premarital sex, the prevalence of which is generally higher in developed countries than in developing countries, and is higher in men than in women. Monogamy is the dominant pattern everywhere, but having had two or more sexual partners in the past year is more common in men than in women, and reported rates are higher in industrialised than in non-industrialised countries. Condom use has increased in prevalence almost everywhere, but rates remain low in many developing countries. The huge regional variation indicates mainly social and economic determinants of sexual behaviour, which have implications for intervention. Although individual behaviour change is central to improving sexual health, efforts are also needed to address the broader determinants of sexual behaviour, particularly those that relate to the social context. The evidence from behavioural interventions is that no general approach to sexual-health promotion will work everywhere and no single-component intervention will work anywhere. Comprehensive behavioural interventions are needed that take account of the social context in mounting individual-level programmes, attempt to modify social norms to support uptake and maintenance of behaviour change, and tackle the structural factors that contribute to risky sexual behaviour.
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              The use of general primers GP5 and GP6 elongated at their 3' ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR.

              M Bartolo, Marc Snijders, Catherina Meijer … (1995)
              Sequence analysis of human papillomavirus (HPV) general primer GP5/6 mediated PCR products revealed the presence of short highly conserved sequences adjacent to the 3' ends of both primers. Part of these sequences was used to elongate GP5 and GP6 at their 3' ends to generate the primers GP5+ and GP6+, respectively. Compared with the GP5/6 PCR, GP5+/6+ specific PCR on 22 cloned mucosotropic HPVs revealed an improved HPV detection, reflected by a 10- to 100-fold higher sensitivity and a markedly increased signal to background ratio, especially at the gel level. As determined on purified DNA, the sensitivity of this GP5+/6+ based assay was at the femtogram level for those HPV genotypes which match strongly with the primers (e.g. HPV-16) and at the picogram level for HPV types (e.g. HPV-39 and -51) having four or more mismatches with one or both primers. Application of both methods on 264 cervical scrapes of a cohort of women participating in a prospective follow-up study revealed an increase of total HPV positivity from 39% (GP5/6 PCR) to 43% (GP5+/6+ PCR) of the scrapes. Additional HPV typing by PCR specific for the HPV-6, -11, -16, -18, -31 and -33 revealed that all GP5+/6+ PCR positive cases which were negative by GP5/6 PCR (n = 12) contained HPV types different from these six types. These data indicate that the GP5+/6+ PCR method provides an increased detection level mainly of uncommon, apparently poorly matched HPV types in cervical scrapes and most likely in the enlargement of the spectrum of HPVs detectable by this assay.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Br J Cancer
                Title: British Journal of Cancer
                Publisher: Nature Publishing Group
                ISSN (Print): 0007-0920
                ISSN (Electronic): 1532-1827
                Publication date (Electronic): 10 March 2009
                Publication date Collection: 31 March 2009
                Publication date (Print): 07 April 2009
                Volume: 100
                Issue: 7
                Pages: 1191-1197
                Affiliations
                [1 ]Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Hospitalet del Llobregat (Barcelona) Avda. Gran Via s/n Km 2,7, Barcelona 080907, Spain
                [2 ]CIBER en Epidemiología y Salud Pública (CIBERESP) Barcelona, Spain
                [3 ]Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Torre La Sabana 300 Oeste del ICE, Piso 7, Sabana Norte, San José, Costa Rica
                [4 ]Department of Pathology, VY University Medical Center PO Box 7057, 1007 MB Amsterdam, The Netherlands
                [5 ]Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, USA
                [6 ]International Agency for Research on Cancer, 150 cours Albert Thomas 69372 Lyon cedex 08, France
                [7 ]Instituto Nacional de Cancerologia Bogotá, Colombia
                Author notes
                [* ]Author for correspondence: klouie@ 123456iconcologia.net
                Article
                Publisher Item ID: 6604974
                DOI: 10.1038/sj.bjc.6604974
                PMC ID: 2670004
                PubMed ID: 19277042
                SO-VID: cd17f5a2-ca04-4ae2-8d19-c2f397bedce5
                Copyright © Copyright 2009, Cancer Research UK
                History
                Date received : 22 January 2009
                Date revision received : 13 February 2009
                Date accepted : 16 February 2009
                Categories
                Subject: Epidemiology

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: child sexual abuse,pregnancy,sexual behaviour,first sexual intercourse,cervical cancer
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: child sexual abuse, pregnancy, sexual behaviour, first sexual intercourse, cervical cancer

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