Women with human papillomavirus (HPV) infection who smoke have a significantly increased risk of developing cervical cancer compared with HPV-infected women who do not smoke, according to a report in the Journal of the National Cancer Institute (09.18.02;94:1406-1414). Of the more than 100 types of HPV, certain ones are the primary cause of cervical cancer. HPV infection usually goes away on its own, however, and most women who get the virus do not develop cervical cancer.

"Smoking, but not oral contraceptive use or past number of live births, was linked with a two- or four-fold increased risk of cervical pre-cancer and cervical cancer in a 10-year follow-up of women who had an HPV infection at the beginning of the study," said lead author Dr. Philip E. Castle. Castle, from the National Cancer Institute in Rockville, Md., and colleagues evaluated 1,812 women who were part of an ongoing cervical cancer study at Kaiser Permanente in Portland, Ore. The women tested positive for HPV and completed a questionnaire on smoking, oral contraception and other factors. After 10 years of follow-up, the researchers found that neither oral contraceptive use nor giving birth was associated with the risk of developing cervical cancer. However, women who smoked one or more packs of cigarettes per day were four times as likely as nonsmokers to develop precancerous or cancerous changes in the cervix. Former smokers had about three times the risk of such changes compared with never-smokers.

Castle said these findings have profound public health implications, particularly in developing countries. "In resource-poor regions of the world where cigarette smoking is now on the rise and there are suboptimal Pap smear screening programs, we are concerned that smoking may contribute to increased rates of cervical cancer," he said.

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