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Cigarettes and Cervices Syzygial? Who Knew?

By mementomori on November 18, 2006.

The following questions are for women only:

1. Have you had a pap smear done this year?
2. Do you smoke cigarettes?
3. Do you know if you are infected with HPV-16 (human papillomavirus type 16)?

If you answered "no" to #1 - see your doctor, please. If you answered "yes" to #2 - click on this link for some great information. If you answered either "yes" or "no" to #3 - please read the rest of this post.

The following question is for men only:

Are there any women in your life that you address as wife, girlfriend, significant other, POSSLQ, mother, daughter, niece, cousin, close friend or even patient, that smoke cigarettes?

If you answered "yes" - perhaps you could ask them to read this post. If you answered "no" - what are you, a caveman? Better pick up this helpful guide tout suite!

The reason I bring this up is because of this little story: Smoking Boosts Cervical Cancer Risk

What is being reported is a study from Sweden where 375 women diagnosed with carcinoma-in-situ (CIS) of the cervix were matched with a control group of 363 women without CIS. All patients had slides from prior Pap smears stored on file , and these smears were used to find DNA evidence of HPV-16 infection. Then the subjects' smoking history was obtained and voila! We find the following interesting conclusions:

1. The median time between the first Pap smear and the diagnosis of CIS was nine years.

2. Women who were positive for HPV-16 on their first Pap smear were eight times more likely to get CIS than those who were HPV-16 negative (800% increase in risk).

3. Women who smoked at the time of their first smear were 70% (or 1.7 times) more likely to develop CIS.

Now comes the nitty-gritty of the study:

4. Non-smoking HPV-16 positive women had a 500% increase (which can also be stated as five times more likely) of CIS compared with HPV-16 negative patients, but women who were both smokers and infected with HPV-16 had an odds ratio of 14.4 compared with smokers not infected with HPV-16.

That's over 14 times more likely, folks, which means that in a hypothetical setting one could tell a teenage daughter who smokes and is sexually active that if she were diagnosed with HPV-16 infection now, her risk of developing cervical cancer over the next decade is 1400% higher than a non-infected smoker. The authors of the study conclude, within the bounds of their data of course, that smoking and HPV-16 are synergistic in causing cervical cancer. To wit:

Our study revealed evidence suggestive of synergism between cigarette smoking (particularly duration of smoking) and HPV-16 in CIS development, which occurs many years before diagnosis of the offending lesion. This supports the results of a small number of studies that have formally tested for an interaction between smoking and HPV in causing CIS. Confirmation of an interaction between cigarette smoking and HPV-16 (and other HPV types) in cervical cancer development from other large-scale studies is of vital importance from a public health perspective, considering the widespread exposure to these agents in young women at risk for cervical cancer.

Did you catch that first parenthetical comment? What they are referring to is that women who were positive for HPV-16 at the time of their first Pap smear and who also had a smoking history of greater than or equal to five years (yes, only five years) had the highest risk of any group - an odds ratio of 36! In other words, these women were 36 times more likely to get CIS than women who also had smoked for at least five years but were HPV-16 negative. Thus the observation that synergy may be taking place between cigarette smoking and the development of cervical cancer.

Gosh, it's a good thing I'm a male, isn't it? Anybody got a light? Hmm? How about you?

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Anti-smoking

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OK, I worry too much.
What about second-hand smoke?

I know I'm infected with HPV--I've been having occasional abnormal Pap smears (and, recently, the occasional colposcopy) for more than 20 years, and I had cryosurgery about 25 years ago. And I used to smoke, but I quit 18 years ago. Any data on either other strains of HPV and smoking, or the long-term effects of quitting? Does the risk start to drop again over time, even if it doesn't get back down to the risks faced by never-smoked-ers?

By Emma Goldman (not verified) on 19 Nov 2006 #permalink

Yes, no and yes...My pediatrician will have the vaccine at the beginning of the year and my daughter already has three appointments to get it. Now if we could vaccinate stupidity maybe we could keep teens from picking up the addiction of smoking.

Yes, no, and most likely no -- not having sex for 15 years and having years of normal pap smears makes 3. extremely unlikely. Not easy to find the right man.... Sometimes I wonder if I should bother with pap smears.
By the way, why are you insisting on yearly intervals when most of current research supports 3- years interval after several years of normal ones?

Dear Kitty: I didn't mean to imply that a woman should not follow the standard Amercian Cancer Society guidelines - I just forgot that they have changed. As penance I am listing the correct information - directly from the ACS website. My apologies.

All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test. Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years with either the conventional (regular) or liquid-based Pap test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually. Another reasonable option for women over 30 is to get screened every 3 years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test (see below for more information on this test). Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health. Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.

Thanks. I am curious about something else. The guidelines seem to assume that by the time a woman is 21 there are no virgins left. Is it because women lie? But why would she - it's not like somebody is going to drug her to a doctor? What about nuns?

Not that I have anything against sex - I am neither conservative nor religious, but some women do choose to wait, not necessarily until marriage but at least until they meet "the right guy". I had my first boyfriend much later than 21, for example. Why would a virgin need to be screened?

So I am really curious about this assumption.

CheerfulOnco,

I have been smoke-free now for 31 HOURS!! I keep thinking though, I am 46, I hve smoked for 30 years. Have I not already done the damage?

My poor husband has already had well over his "30 minutes of 2nd hand smoke" so have I not already killed him too?

I'm not finding a really good reason here to keep on suffering like this.

I would sell my 1st born right this minute for a cigarette.

Maybe 2nd-hand smoke explains why women who don't smoke but live with smokers are more likely (twice as likely?) to get cervical cancer.

You don't have no quit smoking forever! Just for the next five minutes. And the next five. And the next...