Sexual risk factors for cervical cancer among rural Indian women: a case-control study.

BACKGROUND: The association between sexual behaviour and cervical cancer is well established. Despite a high incidence of cervical cancer in India, its role has not been widely investigated in Indian women among whom the rate of sexual promiscuity is known to be very low. A hospital-based case-control study was carried out to investigate the role of sexual risk factors in cervical cancer among rural Indian women. METHODS: A case-control design was used in which a total of 268 subjects, comprising 134 women with invasive cervical cancer as cases and 134 control women were studied. A multiple logistic regression model was used to analyse the data. RESULTS: The risk factors found to be associated with cervical cancer were early age at first coitus, extramarital sex partners of women and the time interval since first exposure. In a multiple logistic regression model, independent effects were observed for early age at first coitus, showing maximum risk in women who reported their first intercourse at < 12 years of age, compared to that of women at > or = 18 years (odds ratio [OR] = 3.5. 95% confidence interval [CI]: 1.1-10.9). Increased risk was also seen for women who had extramarital sex relationships (OR = 5.5, 95% CI: 1.5-19.5). The significant effect of early age at first coitus persisted after adjustment for latency period which also showed its independent risk association with cervical cancer in the multivariate analysis. CONCLUSION: These findings confirm the association between early age at first coitus and cervical cancer in women with a low rate of sexual promiscuity and define the role of these risk factors in cervical carcinogenesis among rural Indian women.

PIP: The association between sex behavior and cervical cancer was investigated among rural Indian women known to have very low levels of promiscuity. 134 women with invasive cervical cancer were matched with 134 controls and analysis performed using a multiple logistic regression model. Risk factors associated with cervical cancer were early age at first coitus, extramarital sex partners of women, and the time interval since first exposure. Independent effects were observed for early age at first coitus, with maximum risk among women who reported their first intercourse at younger than age 12 years compared to that of women at age 18 years or older. Increased risk was also seen for women who had extramarital sex relationships. The significant effect of early age at first coitus persisted after adjustment for a latency period which also showed its independent risk association with cervical cancer in the multivariate analysis.

A case-control study of reproductive risk factors associated with cervical cancer.

Using the logistic-regression technique, a hospital-based case-control study of 177 married women with invasive squamous-cell cervical cancer and 149 hospital-visiting controls enabled evaluation of selected reproductive factors as risks. Early age at marriage was found to be the single best predictor of the disease status. However, those who married late but gave birth to a large number of children were generally found to be suffering from cervical cancer. The results support the hypothesis that it is not so much parity per se that enhances the risk, but the rapidity of multiple pregnancies that matters. Logistic analysis also revealed the independent influence of birth interval on the risk of cervical cancer. These findings warrant serious consideration in future studies, given the obvious implications for prevention. Other implications for the prevention of cervical cancer are briefly discussed.