Association between secondhand smoke exposure and abnormal cervical cytology: A one-to-one matched case-control study
Libin An 1  
Xiaohua Zhou 1
Wentao Li 1
Yang Wang 2
Hongling Shi 1
More details
Hide details
Dalian University, Dalian, China
Jilin Science and Technology Vocational Technical College, Changchun, China
Reproductive Center, First Hospital of Jilin University, Changchun, China
Libin An   

Dalian University, No. 24, Lu Xun Road, Zhongshan District, 116001 Dalian, China
Publish date: 2018-11-23
Tob. Induc. Dis. 2018;16(November):56
The aim was to evaluate the association between secondhand smoke (SHS) exposure and abnormal cervical cytology among Chinese adult women.

A one-to-one matched case-control study was conducted with outpatients of the First Hospital of Jilin University between October 2013 to September 2016. In all, 228 cytologic confirmed new cases of abnormal cervical cytology and the equivalent number of age and ethnic matched controls were interviewed about SHS exposure and related factors.

Although 78.3% of all the participants had been exposed to SHS (78.1% subjects vs 78.5% controls), there were no statistical significance of cervical cytological abnormalities and SHS exposure status (never, former, current exposure), exposure intensity in cigarettes per day (none, 1–9, 10–19, and ≥20), SHS exposure duration in years (none, 1–9, 10–19, and ≥20) and the Brinkman Index (BI) (none, 1–99, 100–399, ≥400) between the two groups. The univariate analysis results showed that there were statistical differences between subjects and controls in marital status, sexual frequency in past year, number of sexual partners, age at first intercourse, age at first delivery. The stratified Cox regression model only showed that the age at first sexual intercourse was associated with the cervical cytological abnormalities (OR=1.206, 95% CI: 1.104– 1.319).

Studies on the association between SHS exposure and cervical lesions have been equivocal. In this study, the SHS exposure could not be detected as an independent risk factor of abnormal cervical cytology among Chinese adult women.

Benard VB, Thomas CC, King J, Massetti GM, Doria-Rose VP, Saraiya M. Vital Signs: Cervical Cancer Incidence, Mortality, and Screening - United States, 2007-2012. Mmwr-Morbidity and Mortality Weekly Report. 2014;63(44):1004-1009.
Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67(1):7-30. doi:10.3322/caac.21387
Chen WQ, Zheng RS, Baade PD, et al. Cancer Statistics in China, 2015. CA Cancer J Clin. 2016;66(2):115-132. doi:10.3322/caac.21338
Cox JT. Management of women with cervical cancer precursor lesions. Obstetrics and Gynecology Clinics of North America. 2002;29(4):787-816. doi:10.1016/s0889-8545(02)00047-5
Tsikouras P, Zervoudis S, Manav B, et al. Cervical cancer: screening, diagnosis and staging. Journal of Buon. 2016;21(2):320-325.
Collins S, Rollason TP, Young LS, Woodman CBJ. Cigarette smoking is an independent risk factor for cervical intraepithelial neoplasia in young women: A longitudinal study. European Journal of Cancer. 2010;46(2):405-411. doi:10.1016/j.ejca.2009.09.015
Roura E, Castellsague X, Pawlita M, et al. Smoking as a major risk factor for cervical cancer and pre-cancer: Results from the EPIC cohort. International Journal of Cancer. 2014;135(2):453-466. doi:10.1002/ijc.28666
Fujita M, Tase T, Kakugawa Y, et al. Smoking, Earlier Menarche and Low Parity as Independent Risk Factors for Gynecologic Cancers in Japanese: A Case-Control Study. Tohoku Journal of Experimental Medicine. 2008;216(4):297-307. doi:10.1620/tjem.216.297
Chen C, Huang Y, Liu X, et al. [Current status of smoking and passive smoking among aged 45 to 65 years old females in five cities of China]. Zhonghua liu xing bing xue za zhi. 2014;35(7):797-801.
World Health Organization. World No Tobacco Day, 31 May 2010. Protect women from tobacco marketing and smoke. Accessed February 6, 2018.
Ward KK, Berenson AB, Breitkopf CR. Passive smoke exposure and abnormal cervical cytology in a predominantly Hispanic population. American Journal of Obstetrics and Gynecology. 2011;204(3). doi:10.1016/j.ajog.2010.10.909
Wu MT, Lee LH, Ho CK, et al. Lifetime exposure to environmental tobacco smoke and cervical intraepithelial neoplasms among nonsmoking Taiwanese women. Archives of Environmental Health. 2003;58(6):353-359.
Chan NL, Yasui Y, Thompson B, et al. Secondhand smoke in the home and pap testing among Vietnamese American women. Asian Pacific Journal of Cancer Prevention. 2007;8(2):178-182.
Patil V, Wahab SN, Zodpey S, Vasudeo ND. Development and validation of risk scoring system for prediction of cancer cervix. Indian Journal of Public Health. 2006;50(1):38-42.
Karimi Zarchi M, Akhavan A, Gholami H, Dehghani A, Naghshi M, Mohseni F. Evaluation of cervical cancer risk-factors in women referred to Yazd-Iran hospitals from 2002 to 2009. Asian Pacific Journal of Cancer Prevention. 2010;11(2):537-538.
Matsumoto K, Oki A, Furuta R, et al. Tobacco smoking and regression of low-grade cervical abnormalities. Cancer Science. 2010;101(9):2065-2073. doi:10.1111/j.1349-7006.2010.01642.x
Natphopsuk S, Settheetham-Ishida W, Sinawat S, Pientong C, Yuenyao P, Ishida T. Risk Factors for Cevical Cancer in Northeastern Thailand: Detailed Analyses of Sexual and Smoking Behavior. Asian Pacific Journal of Cancer Prevention. 2012;13(11):5489-5495. doi:10.7314/apjcp.2012.13.11.5489
Tay SK, Tay KJ. Passive cigarette smoking is a risk factor in cervical neoplasia. Gynecologic Oncology. 2004;93(1):116-120. doi:10.1016/j.ygyno.2003.12.032
Zeng XT, Xiong PA, Wang F, Li CY, Yao J, Guo Y. Passive Smoking and Cervical Cancer Risk: A Meta-analysis Based on 3,230 Cases and 2,982 Controls. Asian Pacific Journal of Cancer Prevention. 2012;13(6):2687-2693. doi:10.7314/apjcp.2012.13.6.2687
Trimble CL, Genkinger JM, Burke AE, et al. Active and passive cigarette smoking and the risk of cervical neoplasia. Obstetrics & Gynecology. 2005;105(1):174-181. doi:10.1097/01.aog.0000148268.43584.03
Ferreira da Silva I, Koifman RJ, Quinto Santos Souza C, Ferreira de Almeida Neto O, Koifman S. TP53 genetic polymorphisms and environmental risk factors associated with cervical carcinogenesis in a cohort of Brazilian women with cervical lesions. Journal of Toxicology and Environmental Health, Part A. 2010;73(13-14):888-900. doi:10.1080/15287391003744823
Coker AL, Rosenberg AJ, McCann MF, Hulka BS. Active and passive cigarette smoke exposure and cervical intraepithelial neoplasia. Cancer Epidemiology, Biomarkers & Prevention. 1992;1(5):349-356.
Louie KS, Castellsague X, de Sanjose S, et al. Smoking and Passive Smoking in Cervical Cancer Risk: Pooled Analysis of Couples from the IARC Multicentric Case-Control Studies. Cancer Epidemiology Biomarkers & Prevention. 2011;20(7):1379-1390. doi:10.1158/1055-9965.epi-11-0284
Waggaman C, Julian P, Niccolai LM. Interactive effects of individual and neighborhood race and ethnicity on rates of high-grade cervical lesions. Cancer Epidemiology. 2014;38(3):248-252. doi:10.1016/j.canep.2014.03.004
Niccolai LM, Russ C, Julian PJ, et al. Individual and geographic disparities in human papillomavirus types 16/18 in high-grade cervical lesions: Associations with race, ethnicity, and poverty. Cancer. 2013;119(16):3052-3058. doi:10.1002/cncr.28038
van Bogaert LJJ. Age at Diagnosis of Preinvasive and Invasive Cervical Neoplasia in South Africa HIV-Positive Versus HIV-Negative Women. International Journal of Gynecological Cancer. 2011;21(2):363-366. doi:10.1097/igc.0b013e3182094d78
Baandrup L, Munk C, Andersen KK, Junge J, Iftner T, Kjaer SK. HPV16 is associated with younger age in women with cervical intraepithelial neoplasia grade 2 and 3. Gynecologic Oncology. 2012;124(2):281-285. doi:10.1016/j.ygyno.2011.10.020
Hwang LY, Ma Y, Benningfield SM, et al. Factors That Influence the Rate of Epithelial Maturation in the Cervix in Healthy Young Women. Journal of Adolescent Health. 2009;44(2):103-110. doi:10.1016/j.jadohealth.2008.10.006
Zhao H, Gu J, Xu H, et al. [Meta-analysis of the relationship between passive smoking population in China and lung cancer]. Zhongguo fei ai za zhi. 2010;13(6):617-623. doi:10.3779/j.issn.1009-3419.2010.06.010
Louie KS, de Sanjose S, Diaz M, et al. Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. British Journal of Cancer. 2009;100(7):1191-1197. doi:10.1038/sj.bjc.6604974
Clements AE, Raker CA, Cooper AS, Boardman LA. Prevalence and patient characteristics associated with CIN 3 in adolescents. American Journal of Obstetrics and Gynecology. 2011;204(2). doi:10.1016/j.ajog.2010.09.008
Gawande V, Wahab SN, Zodpey SP, Vasudeo ND. Parity as a risk factor for cancer cervix. Indian Journal of Medical Sciences. 1998;52(4):147-150.
Damasus-Awatai G, Freeman-Wang T. Human papilloma virus and cervical screening. Current Opinion in Obstetrics & Gynecology. 2003;15(6):473-477. doi:10.1097/00001703-200312000-00003
Lee CH, Peng CY, Li RN, et al. Risk evaluation for the development of cervical intraepithelial neoplasia: Development and validation of risk-scoring schemes. International Journal of Cancer. 2015;136(2):340-349. doi:10.1002/ijc.28982
Luque JS, Tarasenko YN, Li H, Davila CB, Knight RN, Alcantar RE. Utilization of Cervical Cancer Screening Among Hispanic Immigrant Women in Coastal South Carolina. Journal of Racial and Ethnic Health Disparities. 2018;5(3):588-597. doi:10.1007/s40615-017-0404-7