Determinants of the geographic variation of invasive cervical cancer in Costa Rica

RESUMO

The incidence of cervical cancer in Costa Rica is about twice as high in the coastal regions as in the interior. To study these regional variation, we used data from a 1986-1987 case-control study of 192 Costa Rican women with invasive cervical cancer and 372 controls. Risk factors identified included the following The study participant's (1) number of sexual partner, (2) age at first sexual intercourse, (3) number of live births, (4) presence of type 16/18 human papillomavirus (HPV) DNA, (5) venereal disease (VD) history, (6) Pap smear history, and (7) socioeconomic status. The adjusted relative risk (RR) and 95 percent confidence intervals (CI) for each of these risk factors were as follows (1) -4 vs. 1 sexual partner RR = 2.0,95 percent CI = 1.1-3.5; (2) age of initiation -15 vs. 18 years RR = 1.5, 95 percent CI = 0.9-2.5; (3) -6 vs. -1 live birth RR = 1.7, 95 percent CI = 0.7-3.9; (4) HPV 16/18 DNA in cervix RR = 2.8, 95 percent CI = 1.9-4.2; (5) VD history RR = 2.2, 95 percent CI 1.2-4.0; (6) no Pap smear; RR = 2.4 95 percent CI = 1.5-3.8; and (7) low socioeconomic status RR = 2.0, 95 percent CI = 1.2-3.2. The population-attibutable risk related to HPV detection, four or more sexual partners, six or more live births, no prior Pap smear, and low socioeconomic status were 39 percent, 38 percent, 29 percent, and 22 percent, respectively