HPV co-factors related to the development of cervical cancer: Results from a population-based study in Costa Rica

A. Hildesheim, R. Herrero, P. E. Castle, S. Wacholder, M. C. Bratti, M. E. Sherman, A. T. Lorincz, R. D. Burk, J. Morales, A. C. Rodriguez, K. Helgesen, M. Alfaro, M. Hutchinson, I. Balmaceda, M. Greenberg, M. Schiffman

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183 Scopus citations


We examined factors associated with high-grade squamous intraepithelial lesions (HSIL) and cervical cancer among human papillomavirus (HPV)-infected women in a prevalent case-control study conducted within a population-based cohort of 10 077 women in Costa Rica. We compared 146 women with HPV-positive HSIL or cancer (HSIL/CA) against 843 HPV-positive women without evidence of HSIL/CA. Subjects completed a risk factor questionnaire. We evaluated the associations between exposures and HSIL/CA among women positive for any HPV and restricted to those positive for high-risk HPV types. Risk of HSIL/CA increased with increasing number of live births (Ptrend = 0.04). Women who smoked 6+ cigarettes/day had a RR for HSIL/CA of 2.7 (95% CI = 1.1-6.7) compared to non-smokers. Current use of barrier contraceptives was associated with a reduction in risk of HSIL/CA (RR = 0.39; 95% CI = 0.16-0.96). Sexual behaviour and a self-reported history of sexually transmitted diseases (STDs) other than HPV were not associated with HSIL/CA. Oral contraceptive use was associated with HSIL/CA among women with <3 pregnancies. Effects were similar in analysis restricted to women positive for high-risk HPV types. Among women positive for high-risk HPV types, 44% of HSIL/CA could be attributed to multiparity (≥3 pregnancies) and/or smoking. Among HPV-positive women, multiparity and smoking are risk factors for HSIL/CA. Oral contraceptive use may be associated with HSIL/CA in subgroups of women.

Original languageEnglish (US)
Pages (from-to)1219-1226
Number of pages8
JournalBritish journal of cancer
Issue number9
StatePublished - May 4 2001


  • Cancer
  • Cervix
  • Human papillomavirus
  • Parity
  • Smoking

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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