[Papillomavirus and factors associated with high-risk, cervical intraepithelial neoplasia in Cauca, Colombia]. / Papilomavirus y factores asociados a neoplasia intraepitelial cervical de alto grado en Cauca, Colombia.

OBJECTIVE: Evaluating the role of the main factors associated with high-risk cervical intraepithelial neoplasia in women from the Cauca Department in Colombia. METHODOLOGY: After signing a consent-form, women were interviewed to obtain socio-demographic and lifestyle data. A cervical biopsy was performed on each woman for histopathological diagnosis (cases) and a sample of exfoliated cells (cases and controls) to extract DNA for HPV detection by polymerase chain reaction. A total of 98 cases and 109 controls, matched by age and ethnicity, were recruited for the study. RESULTS: The study confirmed association between HPV and the risk of cervical neoplasia (OR = 19.0; 95% CI = 8.20-44.2). The data suggested that multiparity (OR = 4.1; 95% CI = 1.62-10.6) and exposure to carcinogens present in wood-smoke (OR = 7.3; 95% CI = 3.00-19.4) are important co-factors for cervical neoplasia given the presence of HPV. CONCLUSIONS: These results provide valuable information for public health institutions to develop better cervical neoplasia prevention programmes.

Exposure to wood smoke, HPV infection, and genetic susceptibility for cervical neoplasia among women in Colombia.

Cervical cancer is the second leading cause of death from cancer among women in Colombia (16/100,000). Infection with high-risk human papillomavirus (HPV) plays a major role in the etiology of high-grade squamous intraepithelial lesions (HSILs). Exposure to chemical agents may be a cofactor for tumor induction, and individual genetic differences in the metabolism of these chemical agents may affect the susceptibility of individuals towards the development of HSIL. In this case-control study, a total of 91 cases with HSIL and 92 healthy controls, frequency-matched by age and place of origin, were recruited, and their frequencies of CYP2E1, GSTM1, and GSTT1 polymorphism were determined. We then evaluated the association of these polymorphisms, by themselves and in combination with wood smoke exposure and HPV-infection status, with the risk of HSIL. The results indicate that GSTM1 and GSTT1 polymorphism were not associated with HSIL, although a small increase in risk was observed for individuals who were GSTT1 null (OR = 1.4, 95% CI = 0.57-3.44). Contrary to other investigations, the c2/c2 variant of the CYP2E1 gene was associated with a significant increase in risk after adjusting for wood smoke exposure (OR = 6.3, 95% CI = 1.10-36.38) or wood smoke exposure and HPV-infection status (OR = 10.7, 95% CI = 1.76-65.58). Wood smoke exposure also increased the risk of HSIL among CYP2E1 c2/c2 HPV-positive women (OR = 3.3, CI = 0.50-22.50); however, the increase did not achieve statistical significance. Our study provides tantalizing evidence that genetic differences in the metabolism of wood smoke carcinogens, particularly metabolism by CYP2E1, may confer susceptibility for HSIL development. Further investigations with larger populations will be needed to confirm this association, which may provide important information for improving cervical cancer prevention programs.

Papilomavirus y Factores asociados a Neoplasia Intraepitelial Cervical de Alto Grado en Cauca, Colombia / Papillomavirus and factors associated with high-risk, cervical intra-epithelial neoplasia in Cauca, Colombia

Objetivo: Evaluar el papel de los principales factores de riesgo asociados a lesiones intraepiteliales escamosas de alto grado en mujeres del Departamento del Cauca, Colombia. Metodología: Después de la firma de un consentimiento informado, las mujeres fueron encuestadas para la obtención de datos socio-demográficos y de estilo de vida. Adicionalmente, de cada mujer se obtuvo una biopsia cervical para diagnóstico histopatológico (casos) y una muestra de células exfoliadas (casos y controles) para posterior extracción de ADN y detección de papilomavirus (VPH) por reacción en cadena de la polimerasa (PCR). Un total de 98 casos y 109 controles, apareados por edad y procedencia, fueron reclutados para este estudio. Resultados: El estudio confirma la asociación entre VPH y el riesgo de neoplasia cervical (OR=19,0; IC95 por ciento=8,20-44,2). Los datos sugieren que la multiparidad (OR=4,1; IC95 por ciento=1,62-10,6) y la exposición a carcinógenos presentes en el humo de leña (OR=7,3; IC95 por ciento=3,00-19,4) son importantes co-factores de riesgo dada la presencia de VPH. Conclusiones: Estos resultados brindan información valiosa a las instituciones de salud pública para desarrollar mejores programas de promoción y prevención de neoplasia cervical.