RESUMO
BACKGROUND: This cross-sectional study was designed to evaluate the role of cigarette smoking and high-risk HPV types as risk factors of CIN 2 and 3 in young, sexually active Brazilian women. MATERIALS AND METHOD: A series of 100 consecutive women with abnormal Pap smears were recruited, subjected to colposcopy, punch biopsy, and questionnaire for their social, sexual and reproductive factors. Of these, 77 women between 20 and 35 years of age (median 26.5 years) with biopsy-confirmed CIN 1 or CIN 2 and 3, were enrolled in this study. Representative samples from the exocervix and endocervix were obtained for HPV testing with the Hybrid Capture HPV-DNA assay, including the probes for the oncogenic HPV types (16, 18, 31, 33, 35, 45, 51, 52 and 56). RESULTS: The overall rate of CIN 2 and 3 was 23/77 (29.8%). The women with CIN 1, 2 and 3 did not differ from each other with regard to their age, race, schooling, marital status, lifetime number of sexual partners, age at first intercourse, use of oral contraceptives, or parity. However, current cigarette smoking was strongly associated with CIN 2 and 3 (p<0.001), and among smokers, the risk of high-grade CIN increased in parallel with the time of exposure (years of smoking) (p=0.07). HPV-DNA of the oncogenic types was detected in 43 (56%) women, the risk of being HPV DNA-positive was significantly higher in CIN 2 and 3 as compared with CIN 1 (p=0.037). Importantly, the prevalence of high-risk HPV types was significantly higher in cigarette smokers than in non-smokers (p=0.046). CONCLUSIONS: The results indicate that the severity of CIN lesions was clearly related to two fundamental risk factors: 1) high-risk HPV types, and 2) current cigarette smoking. These two risk factors were closely interrelated in that the high-risk HPV types were significantly more frequent in current smokers than in non-smokers, suggesting the possibility of a synergistic action between these two risk factors in cervical carcinogenesis.
Assuntos
Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Fumar/efeitos adversos , Infecções Tumorais por Vírus/complicações , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/etiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/etiologia , Adulto , Biópsia , Brasil/epidemiologia , Estudos Transversais , DNA Viral/isolamento & purificação , Feminino , Humanos , Papillomaviridae/genética , Prevalência , Fatores de Risco , Comportamento Sexual , Inquéritos e Questionários , Neoplasias do Colo do Útero/virologia , Saúde da Mulher , Displasia do Colo do Útero/virologiaRESUMO
The treatment of cervical microinvasive carcinoma is controversial. Hysterectomy is performed in almost all cases, associated or not with more radical procedures. Currently, there is a tendency to adopt conservative management to treat patients with early invasion, as long as it can be assured that the whole lesion has been removed. The aim of this study was to establish which histological information should be obtained from the cones that would give the best possible assurance of absence of residual neoplasia in the patient. This was done by comparing cone and hysterectomy specimens from each patient. One hundred sixty-three cases, treated from 1967 to 1994, underwent simple or radical hysterectomy following cone biopsy. We evaluated the following histological features in the cones: (i) invasion depth, (ii) lateral extension of the lesion, (iii) unifocal or extensive lesion, (iv) vascular invasion, (v) morphological signs of HPV infection, and (vi) free or involved cone surgical margins. Residual neoplasia in the hysterectomy was more frequent when the margins of the cone were involved by atypical epithelium, and in cases with signs of HPV infection. However, according to statistical analysis, these two variables were not mutually independent, and the only important parameter to predict residual neoplasia in the hysterectomy specimens was involved surgical margins in the cone.