CIGARETTE-SMOKING AND HIGH-RISK HPV DNA AS PREDISPOSING FACTORS FOR HIGH-GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) IN YOUNG BRAZILIAN WOMEN

Background. This cross-sectional study was designed to evaluate the ro le of cigarette smoking and high-risk HPV types as risk factors of CIN 2 and 3 in young, sexually active Brazilian women. Materials and meth od. A series of 100 consecutive women with abnormal Pap smears were re cruited, subjected to colposcopy, punch biopsy, and questionnaire for their social, sexual and reproductive factors. Of these, 77 women betw een 20 and 35 years of age (median 26.5 years) with biopsy-confirmed C IN I or CIN 2 and 3, were enrolled in this study. Representative sampl es from the exocervix and endocervix were obtained for HPV testing wit h the Hybrid Capture HPV-DNA assay, including the probes for the oncog enic HPV types (16, 18, 31, 33, 35, 45, 51, 52 and 56). Results. The o verall rate of CIN 2 and 3 was 23/77 (29.8%). The women with CIN 1, 2 and 3 did not differ from each other with regard to their age, race, s chooling, marital status, lifetime number of sexual partners, age at f irst intercourse, use of oral contraceptives, or parity. However, curr ent cigarette smoking was strongly associated with CIN 2 and 3 (p<0.00 1), and among smokers, the risk of high-grade CIN increased in paralle l with the time of exposure (years of smoking) (p=0.07). HPV-DNA of th e oncogenic types was detected in 43 (56%) women, the risk of being HP V DNA-positive was significantly higher in CIN 2 and 3 as compared wit h CIN 1 (p=0.037). Importantly, the prevalence of high-risk HPV types was significantly higher in cigarette smokers than in non-smokers (p=0 .046). Conclusions. The results indicate that the severity of CIN lesi ons was clearly related to two fundamental risk factors: 1) high-risk HPV types, and 2) current cigarette smoking. These two risk factors we re closely interrelated in that the high-risk HPV types were significa ntly more frequent in current smokers than in non-smokers, suggesting the possibility of a synergistic action between these two risk factors in cervical carcinogenesis.