Brief Article
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World J Obstet Gynecol. Aug 10, 2013; 2(3): 53-61
Published online Aug 10, 2013. doi: 10.5317/wjog.v2.i3.53
Smoking and genital human papilloma virus infection in women attending cervical cancer screening in Greece
Kimon Chatzistamatiou, Taxiarchis Katsamagas, Menelaos Zafrakas, Konstantia Zachou, Anastasia Orologa, Fani Fitsiou, Thomas Theodoridis, Theocharis Konstantinidis, Theodoros C Konstantinidis, Theodoros Agorastos
Kimon Chatzistamatiou, Taxiarchis Katsamagas, Theodoros Agorastos, 4th Department of Obstetrics and Gynecology, Hippokrateio Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
Menelaos Zafrakas, School of Health and Medical Care, Alexander Technological Educational Institute of Thessaloniki, 55134 Thessaloniki, Greece
Konstantia Zachou, Anastasia Orologa, Fani Fitsiou, Laboratory of Cytology, Hippokrateio Hospital, 54642 Thessaloniki, Greece
Thomas Theodoridis, Center for Family Planning, Hippokrateio Hospital, 54642 Thessaloniki, Greece
Theocharis Konstantinidis, Peripheral Laboratory of Public Health, Hellenic Center for Disease Control and Prevention, Ministry of Health, 68100 Alexandroupoli, Greece
Theodoros C Konstantinidis, Laboratory of Hygiene and Environmental Protection and Laboratory of Microbiology, Democritus University of Thrace, 68100 Alexandroupoli, Greece
Author contributions: Agorastos T conceived and co-ordinated the study; Chatzistamatiou K drafted the manuscript; Zafrakas M, Konstantinidis TC and Agorastos T revised the manuscript critically for important intellectual content; all authors contributed in data acquisition, analysis and interpretation, as well as in drafting the article; all authors have read and approved the final version of the manuscript.
Correspondence to: Menelaos Zafrakas, Associate Professor of Obstetrics and Gynecology, School of Health and Medical Care, Alexander Technological Educational Institute of Thessaloniki, Ethnikis Antistaseos 81, 55134 Thessaloniki, Greece. mzafrakas@gmail.com
Telephone: +30-2310-222792 Fax: +30-2310-222498
Received: March 20, 2013
Revised: April 9, 2013
Accepted: May 16, 2013
Published online: August 10, 2013
Processing time: 118 Days and 17.4 Hours
Abstract

AIM: To investigate whether smoking is associated with human papilloma virus (HPV) infection.

METHODS: HPV infection is considered to be a necessary condition for cervical cancer development. The study population included 1291 women, aged 25-55 years, attending cervical cancer screening. All women had a Papanicolaou (Pap) test, with liquid-based cytology (Thinprep®), an HPV-DNA test and an evaluation of smoking habits. The COBAS® 4800 system was used for HPV-DNA testing, enabling identification of the following high-risk HPV (hrHPV)-types: each of HPVs 16 and 18 separately, and HPVs 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68 as a cocktail. The evaluation of smoking habits was assessed using the smoking intensity index (SII), a variable formed as the product of cigarettes consumed per day by the days (years × 365) that a woman was a smoker, divided by 1000.

RESULTS: There were 136 smokers among 238 women tested positive for hrHPV-types (HPVs 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and/or 68), and 463 smokers among 1053 hrHPV-negative women (OR = 1.7, P < 0.001). This association was attributed to the youngest age group of women, aged 25-34 years (OR = 2.3, P < 0.001), while there was no association in other age groups. The intensity of smoking (increasing SII) showed no statistically significant association with hrHPV infection. Cervical infection with HPV 16 and/or HPV 18 was also not associated with age or smoking habits. Finally, no association was found between Pap test status and smoking habits or smoking intensity.

CONCLUSION: Smoking appears to be associated with hrHPV infection of the uterine cervix, particularly in younger women. Further studies should investigate whether this association is based on causality and evaluate the role of other possible co-factors.

Keywords: Human papilloma virus; High-risk human papilloma virus; Human papilloma virus-DNA test; Smoking; Cervical cancer; Screening

Core tip: Human papilloma virus (HPV) infection is a prerequisite for cervical cancer development. We investigated whether smoking can influence the course of HPV infection, in 1291 women attending cervical cancer screening. Smoking appeared to be associated with high-risk HPV (hrHPV) infection of the uterine cervix, particularly in younger women, aged 25-34 years. In addition, women in this younger age group with a negative Pap test were more likely to have hrHPV infection if they were smokers than if they did not smoke. Further studies should investigate whether this association is based on causality and evaluate the role of other possible co-factors.