Journal Article

Ranking lifestyle risk factors for cervical cancer among Black women: A case-control study from Johannesburg, South Africa

Chantal Babb de Villiers, Mwiza Gideon Singini, Abram Bunya Kamiza, Melitah Motlhale, Elvira Singh, Mazvita Muchengeti, Wenlong Carl Chen, Tim Waterboer, Freddy Sitas, Debbie Bradshaw, Cathryn M. Lewis, Christopher G. Mathew, Robert Newton

2021

Overview

Aside from human papillomavirus (HPV), the role of other risk factors in cervical cancer such as age, education, parity, sexual partners, smoking and human immunodeficiency virus (HIV) have been described but never ranked in order of priority. We evaluated the contribution of several known lifestyle co-risk factors for cervical cancer among black South African women. We used participant data from the Johannesburg Cancer Study, a case-control study of women recruited mainly at Charlotte Maxeke Johannesburg Academic Hospital between 1995 and 2016. A total of 3,450 women in the study had invasive cervical cancers, 95% of which were squamous cell carcinoma. Controls were 5,709 women with cancers unrelated to exposures of interest. Unconditional logistic regression models were used to calculate adjusted odds ratios (ORadj) and 95% confidence intervals (CI). We ranked these risk factors by their population attributable fractions (PAF), which take the local prevalence of exposure among the cases and risk into account. Cervical cancer in decreasing order of priority was associated with (1) being HIV positive (ORadj = 2.83, 95% CI = 2.53-3.14, PAF = 17.6%), (2) lower educational attainment (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 16.2%), (3) higher parity (3+ children vs 2-1 children (ORadj = 1.25, 95% CI = 1.07-1.46, PAF = 12.6%), (4) hormonal contraceptive use (ORadj = 1.48, 95% CI = 1.24-1.77, PAF = 8.9%), (5) heavy alcohol consumption (ORadj = 1.44, 95% CI = 1.15-1.81, PAF = 5.6%), (6) current smoking (ORadj = 1.64, 95% CI = 1.41-1.91, PAF = 5.1%), and (7) rural residence (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 4.4%). This rank order of risks could be used to target educational messaging and appropriate interventions for cervical cancer prevention in South African women.

• Publisher: Public Library of Science (PLoS),Public Library of Science
• Subject: Adult / Alcohol / Alcohol use / Alcoholism / Alcoholism - complications / Alcoholism - epidemiology / Alcoholism - ethnology / Biology and Life Sciences / Birth control / Brenner, Sydney / Cancer / Carcinoma, Squamous Cell / Carcinoma, Squamous Cell - epidemiology / Carcinoma, Squamous Cell - ethnology / Carcinoma, Squamous Cell - virology / Case studies / Case-Control Studies / Cervical cancer / Cervix / Cervix uteri -- Cancer -- Epidemiology / Children / Confidence intervals / Contraceptives / Education / Engineering and Technology / Epidemiology / Evaluation / Female / Genetics / Health behavior / Health sciences / HIV / Hospitals, Teaching / Human immunodeficiency virus / Human papillomavirus / Humans / Infections / Invasiveness / Laboratories / Life sciences / Life Style / Lifestyles / Logistic Models / Medical research / Medical screening / Medicine / Medicine and Health Sciences / Middle Aged / Morphology / Papillomavirus Infections / Papillomavirus Infections - epidemiology / Papillomavirus Infections - ethnology / Parity / Pathogenesis / People and Places / Pregnancy / Prevalence / Prevention / Public health / Q / Questionnaires / R / Regression analysis / Regression models / Risk analysis / Risk factors / Science / Sexual partners / Sexually transmitted diseases / Smoking / Smoking - adverse effects / Smoking - epidemiology / South Africa / South Africa - epidemiology / Squamous cell carcinoma / Statistical analysis / STD / Uterine Cervical Neoplasms / Uterine Cervical Neoplasms - epidemiology / Uterine Cervical Neoplasms - ethnology / Uterine Cervical Neoplasms - virology / Viruses / Womens health