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Cervical Cancer Risk Linked to Smoking

United Press International

PORTLAND, Ore., (United Press International via COMTEX) -- For women infected with the human papilloma-virus, smoking increases the risk of developing pre-cancer or cancer of the cervix while birth control pills and number of children seem to have no connection, a new 10-year study reports.

Although most women develop HPV infections at some time in their lives, and though it usually clears up spontaneously, HPV also is associated with cervical cancer.

Researchers studied 1,800 women, ages 16 or older, who were infected with HPV and who received their healthcare through Kaiser Permanente in Portland. Among those who smoked more than a pack a day, about 7 percent developed a pre-cancerous condition called cervical intra-epithelial neoplasia, grade 3, or CIN3. Or, they developed cancer of the cervix.

The combined rate for pre-cancer and cancer among HPV-infected women who never smoked was about 2.5 percent. Former smokers had about a 5 percent combined risk. The risk levels were determined after accounting for factors such as age, Pap smear results at start of study and Pap screening frequency.

"We found that smoking -- but not oral contraceptive use or past number of live births -- was linked to a two-to-fourfold increased risk of cervical pre-cancer and cancer among women who had an HPV infection," Philip E. Castle, the study's lead author, told United Press International. Castle is an epidemiologist with the National Cancer Institute's division of cancer epidemiology and genetics.

Carolyn D. Runowicz, a member of the national board of directors of the American Cancer Society and a gynecologic oncologist at St. Luke's-Roosevelt Hospital in New York City, said the new study avoids many of the shortcomings of previous research and brings needed clarity to the connection between smoking and cervical cancer. However, Runowicz said it already is routine practice for her to caution women who test positive with a Pap smear to stop smoking.

"If you talk to young women and you tell them to stop smoking and you tell them they're going to die from lung cancer at age 60, they'll say, 'Okay. Fine. At 60, I'm ready to die,'" Runowicz said. "But if you take a young kid who's 18 to 30 and you tell her that the smoking is affecting her potential for reproduction, you bring the message home for her ... The young kids will start to cry. They'll get very scared that they'll really harm themselves."

Runowicz also noted September is gynecologic cancer awareness month.

The increased rates of cervical pre-cancer and cancer may be due to DNA mutations caused by chemicals in the cigarette smoke, G. Paolo Dotto, a professor of dermatology who studies cervical cancer and HPV at Harvard Medical School in Cambridge, Mass., told UPI. Or, they may be due to abnormal regulation of the genetic material in the epithelial cells of the cervix, he said.

"Besides its mutagenic potential, my sense is that smoking could affect epigenetic control of cellular genes that control cervical carcinoma development, such as the Notch1 gene that we are studying," Dotto said.

The results are reported in the September 18 issue of the Journal of the National Cancer Institute.

(Reported by Joe Grossman, UPI Science News, in Santa Cruz, Calif.)

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