DIFFERENT RISK FACTOR PATTERNS FOR HIGH-GRADE AND LOW-GRADE INTRAEPITHELIAL LESIONS ON THE CERVIX AMONG HPV-POSITIVE AND HPV-NEGATIVE YOUNG-WOMEN

`Risk factors for cervical intraepithelial neoplasia have most often b een studied in high-grade lesions. Furthermore, in a high proportion o f the studies, human papillomavirus (HPV), the most significant risk d eterminant of cervical neoplasia, was not taken into account when eval uating other risk factors. To compare risk factors for ASCUS (atypical cells of undetermined significance), LSIL (low-grade squamous intraep ithelial lesion) and HSIL (high-grade squamous intraepithelial lesion) , we conducted a case-control study among 20 to 29 year-old women part icipating in a prospective cohort study in Copenhagen. It included 131 women with ASCUS, 120 women with LSIL, 79 women with HSIL and 1,000 r andomly chosen, cytologically normal, control women. All participants had a personal interview and a gynecological examination including a P ap smear and cervical swabs for HPV DNA detection using general primer -mediated polymerase chain reaction. The most significant risk determi nant of all 3 disease categories was the presence of genital HPV DNA. The risk factor pattern was nearly identical for ASCUS and LSIL, but d iffered significantly from that for HSIL. Stratified analysis by HPV-s tatus showed that, apart from, respectively, smoking and parity among HPV-positive women, and smoking and number of sex partners among HPV-n egative women, no additional risk factors were observed for ASCUS and LSIL. In contrast, among HPV-negative women with HSIL, long-term use o f oral contraceptives was the most important risk factor. However, our result should be taken with great caution as it is based on very smal l numbers, and as it is unknown whether the HPV-negative lesions const itute a true entity. Among HPV-positive women, the risk of HSIL was as sociated with e.g., years of sex life without barrier contraceptive us e, early age at first genital warts and smoking. Whether the risk fact ors that are applicable only to HSIL represent factors related to prog ression remains unknown. (C) 1998 Wiley-Liss, Inc.