Journal Article

Investigating the effect of sexual behaviour on oropharyngeal cancer risk: a methodological assessment of Mendelian randomization

Burrows, Kimberley, Severino, Patricia, Kachuri, Linda, Martin, Richard M., Munafò, Marcus R., Brenner, Nicole, Tyrrell, Jessica, Lacko, Martin, Waterboer, Tim, Boccia, Stefania, Thomas, Steven J., Ness, Andrew R., Diergaarde, Brenda, Gormley, Mark, Dudding, Tom, Toporcov, Tatiana N., Hung, Rayjean J., Tajara, Eloiza H., Smith, George Davey, Vincent, Emma E., Brennan, Paul, Pring, Miranda, Richmond, Rebecca C., Liu, Geoffrey, Chong, Amanda H. W., Olshan, Andrew F.

2022

Overview

Background Human papilloma virus infection is known to influence oropharyngeal cancer (OPC) risk, likely via sexual transmission. However, sexual behaviour has been correlated with other risk factors including smoking and alcohol, meaning independent effects are difficult to establish. We aimed to evaluate the causal effect of sexual behaviour on the risk of OPC using Mendelian randomization (MR). Methods Genetic variants robustly associated with age at first sex (AFS) and the number of sexual partners (NSP) were used to perform both univariable and multivariable MR analyses with summary data on 2641 OPC cases and 6585 controls, obtained from the largest available genome-wide association studies (GWAS). Given the potential for genetic pleiotropy, we performed a number of sensitivity analyses: (i) MR methods to account for horizontal pleiotropy, (ii) MR of sexual behaviours on positive (cervical cancer and seropositivity for Chlamydia trachomatis ) and negative control outcomes (lung and oral cancer), (iii) Causal Analysis Using Summary Effect estimates (CAUSE), to account for correlated and uncorrelated horizontal pleiotropic effects, (iv) multivariable MR analysis to account for the effects of smoking, alcohol, risk tolerance and educational attainment. Results In univariable MR, we found evidence supportive of an effect of both later AFS (IVW OR = 0.4, 95%CI (0.3, 0.7), per standard deviation (SD), p = < 0.001) and increasing NSP (IVW OR = 2.2, 95%CI (1.3, 3.8) per SD, p = < 0.001) on OPC risk. These effects were largely robust to sensitivity analyses accounting for horizontal pleiotropy. However, negative control analysis suggested potential violation of the core MR assumptions and subsequent CAUSE analysis implicated pleiotropy of the genetic instruments used to proxy sexual behaviours. Finally, there was some attenuation of the univariable MR results in the multivariable models (AFS IVW OR = 0.7, 95%CI (0.4, 1.2), p = 0.21; NSP IVW OR = 0.9, 95%CI (0.5 1.7), p = 0.76). Conclusions Despite using genetic variants strongly related sexual behaviour traits in large-scale GWAS, we found evidence for correlated pleiotropy. This emphasizes a need for multivariable approaches and the triangulation of evidence when performing MR of complex behavioural traits.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Alcohol / Analysis / Attenuation / Biobanks / Biomedicine / Cancer / Care and treatment / Cervical cancer / Cervix / Diagnosis / Disease transmission / Genetic analysis / Genetic diversity / Genetic variance / Genetic variation / Genome-Wide Association Study / Genomes / Head & neck cancer / Head and neck cancer / Health risks / Human papillomavirus / Humans / Lung cancer / Medicine / Medicine & Public Health / Mendelian randomization / Mendelian Randomization Analysis - methods / Oral cancer / Oropharyngeal cancer / Oropharyngeal Neoplasms - epidemiology / Oropharyngeal Neoplasms - genetics / Papillomavirus infections / Pleiotropy / Polymorphism, Single Nucleotide / Prevention / Randomization / Research Article / Risk analysis / Risk factors / Sensitivity analysis / Sex / Sexual Behavior / Sexual behaviour / Sexual intercourse / Sexual partners / Sexually transmitted diseases / Smoking / Smoking - adverse effects / Smoking - epidemiology / STD / Throat cancer / Triangulation / Viruses