Risk factors for rapid-onset cervical cancer,☆☆

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Abstract

Objectives: The current study was designed to elucidate risk factors associated with the development of cervical cancer during the course of routine Papanicolaou smear screening (rapid-onset cervical cancer). Study Design: Four hundred eighty-three women diagnosed with invasive cervical cancer, representing 73% of all such tumors diagnosed in Connecticut between 1985 and 1990, were studied. Papanicolaou smear screening and risk factor information was obtained by questionnaire and physician record review. Results from human papillomavirus deoxyribonucleic acid testing by polymerase chain reaction of tumor samples were available for 278 study participants. Prediagnostic Papanicolaou smear slides were reviewed for 67% of cases with a screening history. Screening history information, slide review, and questionnaire data were used to classify women as having rapid-onset cervical cancer (n = 43), possible rapid-onset cervical cancer (n = 111), or normal-onset cervical cancer (n = 329). Results: Compared with normal-onset cases, rapid-onset cases tended to be younger (P = .001) and were more likely to be white (P = .002), diagnosed with adenocarcinomas or adenosquamous carcinomas (P = .001), and diagnosed with early-stage disease (P = .001). Cases diagnosed as possible rapid-onset disease tended to have a profile that was intermediate to that observed for rapid-onset and normal-onset cases. Human papillomavirus deoxyribonucleic acid was detected in 75.2% of cases tested. Compared with women who tested positive for human papillomavirus type 16 or other, those positive for human papillomavirus type 18 had a relative risk for rapid-onset disease of 1.6 (95% confidence interval 0.52-4.9). No significant association was observed between type 18 and possible rapid-onset disease when possible rapid-onset cases were compared with women diagnosed with normal-onset cervical cancer (relative risk 0.67, 95% confidence interval 0.29-1.6). Oral contraceptive use, cigarette smoking, number of pregnancies, and a maternal history of cervical cancer were not significantly associated with rapid-onset disease. Conclusions: Results from this study suggest that the risk factors associated with the development of rapid-onset cervical cancer are similar to those for normal-onset disease. (Am J Obstet Gynecol 1999;180:571-7.)

Section snippets

Methods

The current study is part of a population-based investigation undertaken in Connecticut to examine patterns of cervical cancer screening and ways in which screening could be improved to further reduce cervical cancer incidence.10, 14 After institutional review board approval, all histologically confirmed incident cervical cancer cases were sought by a rapid ascertainment system set up through the Connecticut tumor registry. During the period from March 1, 1985, through February 23, 1990, 664

Results

Analysis was performed on the 329 women classified as having normal-onset cervical cancer, 111 women classified as having possible rapid-onset cancer, and 43 women with rapid-onset disease. Women diagnosed with rapid-onset tumors were found to differ significantly from those diagnosed with normal-onset disease with respect to all demographic and clinicohistologic factors examined (Table I).

. Demographic and clinicohistologic features of cervical cancer cases by rapid-onset status

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Comment

Consistent with previous reports, we observed that women classified as having rapid-onset cervical cancer were more likely than normal-onset cases to be diagnosed with glandular tumors (adenocarcinomas and adenosquamous carcinomas).9 Although glandular tumors have been reported to account for 10% to 20% of cervical cancer cases, among our group of rapid-onset cases nearly 42% of cases were diagnosed with a carcinoma containing a glandular component.19 The suggestion that glandular tumors of the

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    Reprint requests: Allan Hildesheim, PhD, Interdisciplinary Studies Section, Environmental Epidemiology Branch, DCEG, National Cancer Institute, 6130 Executive Blvd, Room 443, Rockville, MD 20852.

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