Browse > Article
http://dx.doi.org/10.7314/APJCP.2015.16.9.3893

Multiple Sexual Partners as a Potential Independent Risk Factor for Cervical Cancer: a Meta-analysis of Epidemiological Studies  

Liu, Zhi-Chang (School of Public Health, Guangdong Key Laboratory of Molecular Epidemiology)
Liu, Wei-Dong (School of Public Health, Guangdong Key Laboratory of Molecular Epidemiology)
Liu, Yan-Hui (College of Pharmacy, Guangdong Pharmaceutical University)
Ye, Xiao-Hua (School of Public Health, Guangdong Key Laboratory of Molecular Epidemiology)
Chen, Si-Dong (School of Public Health, Guangdong Key Laboratory of Molecular Epidemiology)
Publication Information
Asian Pacific Journal of Cancer Prevention / v.16, no.9, 2015 , pp. 3893-3900 More about this Journal
Abstract
It's known that having multiple sexual partners is one of the risk factors of human papillomavirus (HPV) infection which is a major cause of cervical cancer. However, it is not clear whether the number of sexual partners is an independent risk factor for cervical cancer. We identified relevant studies by searching the databases of MEDLINE, PubMed and ScienceDirect published in English from January 1980 to January 2014. We analyzed those studies by combining the study-specific odds ratios (ORs) using random-effects models. Forty-one studies were included in this meta-analysis. We observed that the number of sexual partners was associated with the occurrence of non-malignant cervical disease (OR=1.82, 95%CI 1.63-2.00) and invasive cervical carcinoma (OR=1.77, 95%CI 1.50-2.05). Subgroup analyses revealed that the association remained significant after controlling for HPV infection (OR=1.52, 95%CI 1.21-1.83 for non-malignant disease; OR=1.53, 95%CI 1.30-1.76 for invasive cervical carcinoma). We found that there was a non-linear relation of the number of sexual partners with both non-malignant cervical disease and invasive cervical carcinoma. The risk of both malignant and non-malignant disease is relatively stable in women with more than 4-7 sexual partners. Furthermore, the frequency-risk of disease remained significant after controlling for HPV infection.The study suggested that h aving multiple sexual partners, with or without HPV infection, is a potential risk factor of cervical cancer.
Keywords
Multiple sexual partners; cervical cancer; meta-analysis; HPV infection;
Citations & Related Records
연도 인용수 순위
  • Reference
1 (2006). Cervical carcinoma and reproductive factors: collaborative reanalysis of individual data on 16,563 women with cervical carcinoma and 33,542 women without cervical carcinoma from 25 epidemiological studies. INT J CANCER, 119, 1108-24.   DOI
2 (2009). Cervical carcinoma and sexual behavior: collaborative reanalysis of individual data on 15,461 women with cervical carcinoma and 29,164 women without cervical carcinoma from 21 epidemiological studies. Cancer Epidemiol Biomarkers Prev, 18, 1060-9.   DOI
3 Begg CB, Mazumdar M (1994). Operating characteristics of a rank correlation test for publication bias. BIOMETRICS, 50, 1088-101.   DOI
4 Bosch FX, Munoz N, de Sanjose S, et al (1992). Risk factors for cervical cancer in Colombia and Spain. INT J CANCER, 52, 750-8.   DOI
5 Boyd JT, Doll R (1964). A study of the aetiology of carcinoma of the cervix uteri. Br J Cancer, 13, 419-34.
6 Brisson J, Morin C, Fortier M, et al (1994). Risk factors for cervical intraepithelial neoplasia: differences between lowand high-grade lesions. AM J EPIDEMIOL, 140, 700-10.
7 Brisson J, Roy M, Fortier M, et al (1988). Condyloma and intraepithelial neoplasia of the uterine cervix: a case-control study. AM J EPIDEMIOL, 128, 337-42.
8 Buckley JD, Harris RW, Doll R, et al (1981). Case-control study of the husbands of women with dysplasia or carcinoma of the cervix uteri. LANCET, 2, 1010-5.
9 Castellsague X, Diaz M, de Sanjose S, et al (2006). Worldwide human papillomavirus etiology of cervical adenocarcinoma and its cofactors: implications for screening and prevention. J Natl Cancer Inst, 98, 303-15.   DOI
10 Coker AL, Rosenberg AJ, McCann MF, et al (1992). Active and passive cigarette smoke exposure and cervical intraepithelial neoplasia. Cancer Epidemiol Biomarkers Prev, 1, 349-56.
11 Egger M, Davey SG, Schneider M, et al (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315, 629-34.   DOI
12 Hernandez-Hernandez DM, Ornelas-Bernal L, Guido-Jimenez M, et al (2003). Association between high-risk human papillomavirus DNA load and precursor lesions of cervical cancer in Mexican women. GYNECOL ONCOL, 90, 310-7.   DOI
13 Herrero R, Brinton LA, Reeves WC, et al (1990). Sexual behavior, venereal diseases, hygiene practices, and invasive cervical cancer in a high-risk population. CANCER-AM CANCER SOC, 65, 380-6.
14 Herrington CS (1999). Do HPV-negative cervical carcinomas exist?--revisited. J PATHOL, 189, 1-3.   DOI
15 Kim J, Kim BK, Lee CH, et al (2012). Human papillomavirus genotypes and cofactors causing cervical intraepithelial neoplasia and cervical cancer in Korean women. INT J GYNECOL CANCER, 22, 1570-6.
16 Higgins JP, Thompson SG (2002). Quantifying heterogeneity in a meta-analysis. STAT MED, 21, 1539-58.   DOI
17 Higgins JP, Thompson SG, Deeks JJ, et al (2003). Measuring inconsistency in meta-analyses. BMJ, 327, 557-60.   DOI
18 Kanjanavirojkul N, Pairojkul C, Yuenyao P, et al (2006). Risk factors and histological outcome of abnormal cervix with human papilloma infection in northeastern Thai-women. Asian Pac J Cancer Prev, 7, 567-70.
19 Kjaer SK (1998). Risk factors for cervical neoplasia in Denmark. APMIS Suppl, 80, 1-41.
20 Kjaer SK, van den Brule AJ, Bock JE, et al (1996). Human papillomavirus--the most significant risk determinant of cervical intraepithelial neoplasia. INT J CANCER, 65, 601-6.   DOI
21 Kjellberg L, Hallmans G, Ahren AM, et al (2000). Smoking, diet, pregnancy and oral contraceptive use as risk factors for cervical intra-epithelial neoplasia in relation to human papillomavirus infection. Br J Cancer, 82, 1332-8.   DOI
22 Malamba SS, Wagner HU, Maude G, et al (1994). Risk factors for HIV-1 infection in adults in a rural Ugandan community: a case-control study. AIDS, 8, 253-7.   DOI
23 McDougall JA, Madeleine MM, Daling JR, et al (2007). Racial and ethnic disparities in cervical cancer incidence rates in the United States, 1992-2003. Cancer Causes Control, 18, 1175-86.   DOI
24 Millikan RC (1994). Epidemiologic evidence showing that human papillomavirus infection causes most cervical intraepithelial neoplasia. J Natl Cancer Inst, 86, 392-3.
25 Parazzini F, La Vecchia C, Negri E, et al (1988). Risk factors for adenocarcinoma of the cervix: a case-control study. Br J Cancer, 57, 201-4.   DOI
26 Moher D, Liberati A, Tetzlaff J, et al (2010). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. INT J SURG, 8, 336-41.   DOI   ScienceOn
27 Olsen AO, Dillner J, Gjoen K, et al (1996). A population-based case-control study of human papillomavirus-type-16 seropositivity and incident high-grade dysplasia of the uterine cervix. INT J CANCER, 68, 415-9.   DOI
28 Orsini N, Li R, Wolk A, et al (2012). Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. AM J EPIDEMIOL, 175, 66-73.   DOI
29 Parazzini F, La Vecchia C, Negri E, et al (1992). Risk factors for cervical intraepithelial neoplasia. CANCER-AM CANCER SOC, 69, 2276-82.
30 Rostad B, Schei B, Da CF (2003). Risk factors for cervical cancer in Mozambican women. Int J Gynaecol Obstet, 80, 63-5.   DOI
31 Schroder KE, Carey MP, Vanable PA (2003). Methodological challenges in research on sexual risk behavior: II. Accuracy of self-reports. Ann Behav Med, 26, 104-23.   DOI
32 Sitas F, Pacella-Norman R, Carrara H, et al (2000). The spectrum of HIV-1 related cancers in South Africa. INT J CANCER, 88, 489-92.   DOI
33 Thomas DB, Qin Q, Kuypers J, et al (2001). Human papillomaviruses and cervical cancer in Bangkok. II. Risk factors for in situ and invasive squamous cell cervical carcinomas. AM J EPIDEMIOL, 153, 732-9.   DOI
34 Wang PD, Lin RS (1996). Risk factors for cervical intraepithelial neoplasia in Taiwan. GYNECOL ONCOL, 62, 10-8.   DOI
35 Vaccarella S, Franceschi S, Herrero R, et al (2006). Sexual behavior, condom use, and human papillomavirus: pooled analysis of the IARC human papillomavirus prevalence surveys. Cancer Epidemiol Biomarkers Prev, 15, 326-33.   DOI
36 Velema JP, Ferrera A, Figueroa M, et al (2002). Burning wood in the kitchen increases the risk of cervical neoplasia in HPV-infected women in Honduras. INT J CANCER, 97, 536-41.   DOI
37 Walboomers JM, Jacobs MV, Manos MM, et al (1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J PATHOL, 189, 12-9.   DOI
38 Ye X, Fu J, Yang Y, et al (2013). Dose-risk and duration-risk relationships between aspirin and colorectal cancer: a meta-analysis of published cohort studies. PLOS ONE, 8, e57578.   DOI
39 Yoo KY, Kang D, Koo HW, et al (1997). Risk factors associated with uterine cervical cancer in Korea: a case-control study with special reference to sexual behavior. J EPIDEMIOL, 7, 117-23.   DOI
40 Zunzunegui MV, King MC, Coria CF, et al (1986). Male influences on cervical cancer risk. AM J EPIDEMIOL, 123, 302-7.