- Volume 13 Issue 6
DOI QR Code
Socio Demographic and Reproductive Risk Factors for Cervical Cancer - a Large Prospective Cohort Study from Rural India
- Thulaseedharan, Jissa V. (Achutha Menon Centre for Health Sciences Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)) ;
- Malila, Nea (School of Health Sciences (HES), University of Tampere) ;
- Hakama, Matti (School of Health Sciences (HES), University of Tampere) ;
- Esmy, Pulikottil O. (Christian Fellowship Community Health Centre) ;
- Cheriyan, Mary (Christian Fellowship Community Health Centre) ;
- Swaminathan, Rajaraman (Cancer Institute (WIA)) ;
- Muwonge, Richard (International Agency for Research on Cancer (IARC)) ;
- Sankaranarayanan, Rengaswami (International Agency for Research on Cancer (IARC))
- Published : 2012.06.30
Background: India shows some of the highest rates of cervical cancer worldwide, and more than 70% of the population is living in rural villages. Prospective cohort studies to determine the risk factors for cervical cancer are very rare from low and medium resource countries. The aim of this study was to quantify the effect of risk factors related to cervical cancer in a rural setting in South India. Material and methods: Sociodemographic and reproductive potential risk factors for cervical cancer were studied using the data from a cohort of 30,958 women who constituted the unscreened control group in a randomised screening trial in Dindigul district, Tamilnadu, India. The analysis was accomplished with the Cox proportional hazard regression model. Results: Women of increasing age (HR=2.4; 95% CI: 1.6, 3.8 in 50-59 vs 30-39), having many pregnancies (HR=7.1; 1.0, 52 in 4+ vs 0) and no education (HR=0.6; 0.2, 0.7 in high vs none) were found to be at significantly increased risk of cervical cancer. Conclusion: This cohort study gives very strong evidence to say that education is the fundamental factor among the sociodemographic and reproductive determinants of cervical cancer in low resource settings. Public awareness through education and improvements in living standards can play an important role in reducing the high incidence of cervical cancer in India. These findings further stress the importance of formulating public health policies aimed at increasing awareness and implementation of cervical cancer screening programmes.
- Biswas LN, Manna B, Maiti PK, Sengupta S (1997). Sexual risk factors for cervical cancer among rural Indian women: a case-control study. Int J Epidemiol, 26, 491-5. https://doi.org/10.1093/ije/26.3.491
- Bosch FX, Lorincz A, Munoz N, Meijer CJ, Shah KV ( 2002). The causal relation between human papillomavirus and cervical cancer. J Clin Pathol, 55, 244-65. https://doi.org/10.1136/jcp.55.4.244
- Boyle P, Levin B (2008). World Cancer Report 2008. IARC, WHO Press, World Health Organization, Geneva, 27, Switzerland.
- Cherian Varghese (2000). Prevalence and Determinants of Human Papilloma Virus (HPV) infection in Kerala, India. Acta Universitatis Tamperensis 755,University of Tampere.
- Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917. https://doi.org/10.1002/ijc.25516
- Ferrera A, Velema JP, Figueroa M, et al (2000). Co-factors related to the causal relationship between human papillomavirus and invasive cervical cancer in Honduras. Int J Epidemiol, 29, 817-25. https://doi.org/10.1093/ije/29.5.817
- Franceschi S, Rajkumar T, Vaccarella S, et al (2003).Human papillomavirus and risk factors for cervical cancer in Chennai, India: a case-control study. Int J Cancer, 107, 127-33. https://doi.org/10.1002/ijc.11350
- Franceschi S, Rajkumar R, Snijders PJ, et al (2005). Papillomavirus infection in rural women in southern India. Bri J Cancer, 92, 601-6.
- Giftson S, Umadevi P, Kannika PS (2011). The present scenario of cervical cancer control and HPV epidemiology in India: an outline. Asian Pac J Cancer Prev, 12, 1107-15.
- Hinkula M, Pukkala E, Kyyronen P, et al (2004).A populationbased study on the risk of cervical cancer and cervical intraepithelial neoplasia among grand multiparous women in Finland. Br J Cancer, 90, 1025-9. https://doi.org/10.1038/sj.bjc.6601650
- Juneja A, Sehgal A, Mitra AB, Pandey A (2003). A survey on risk factors associated with cervical cancer. Indian J Cancer, 40, 15-22.
- Kaku M, Mathew A, Rajan B (2008). Impact of socio-economic factors in delayed reporting and late-stage presentation among patients with cervix cancer in a major cancer hospital in South India. Asian Pac J Cancer Prev, 9, 589-94.
- Louie KS, De Sanjose S, Diaz M, et al (2009).Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. Bri J Cancer, 100, 1191-7. https://doi.org/10.1038/sj.bjc.6604974
- Mathew A, George PS (2009).Trends in incidence and mortality rates of squamous cell carcinoma and adenocarcinoma of cervix - worldwide. Asian Pac J Cancer Prev, 10, 645-50.
- Mukherjee BN, Sengupta S, Chaudhuri S, Biswas LN,Maiti P(1994). A case-control study of reproductive risk factors associated with cervical cancer. Int J Cancer, 59, 476-82. https://doi.org/10.1002/ijc.2910590408
- Rajkumar R, Sankaranarayanan R, Esmy PO, et al (2000). Leads to cancer control based on cancer patterns in a rural population in South India. Cancer Causes Control, 11, 433-9. https://doi.org/10.1023/A:1008900425151
- Rughooputh S, Kachaliya S, Jetly D, Greenwell P (2007). Cervical cancer and human papillomavirus among slum dwellers in India. Br J Bio Sci, 64, 28-31.
- Saha A, Nag Chaudhary A, Bhowmik P, Chatterjee R (2010). Awareness of cervical cancer among female students of premier colleges in Kolkata, India. Asian Pac J Cancer Prev, 11, 1085-90.
- Sankaranarayanan R, Bhatla N, Gravitt PE, et al (2008). Human papillomavirus infection and cervical cancer prevention in India, Bangladesh, Sri Lanka and Nepal. Vaccine, 26, 43-52. https://doi.org/10.1016/j.vaccine.2008.05.005
- Sankaranarayanan R, Chatterji R, Shastri SS, et al (2004b). Accuracy of human papillomavirus testing in primary screening of cervical neoplasia: results from a multicenter study in India. Int J Cancer, 112, 341-7. https://doi.org/10.1002/ijc.20396
- Sankaranarayanan R, Esmy PO, Rajkumar R, et al (2007). Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial. Lancet, 370, 398-406. https://doi.org/10.1016/S0140-6736(07)61195-7
- Sankaranarayanan R, Nene BM, Shastri SS, et al (2009). HPV screening for cervical cancer in rural India. New England J Med, 360, 1385-94. https://doi.org/10.1056/NEJMoa0808516
- Sankaranarayanan R, Rajkumar R, Arrossi S, et al (2003). Determinants of participation of women in a cervical cancer visual screening trial in rural south India. Cancer Detection Prev, 27, 457-65. https://doi.org/10.1016/j.cdp.2003.09.006
- Sankaranarayanan R, Rajkumar R, Theresa R, et al (2004a). Initial results from a randomized trial of cervical visual screening in rural south India. Int J Cancer, 109, 461-7. https://doi.org/10.1002/ijc.11726
- Sauvaget C, Nene BM, Jayant K, et al ( 2011). Prevalence and determinants of high-risk human papillomavirus infection in middle-aged Indian women. Sex Transm Dis, 38, 902-6. https://doi.org/10.1097/OLQ.0b013e318223be5f
- Sellors JW, Sankaranarayanan R (2003). Colposcopy and Treatment on Cervical Intraepithelial Neoplasia : A Beginners' Manual. IARCPress, Lyon, France.
- Stewart B W & Kleihues P (eds) (2003). World Cancer Report. IARC Press, Lyon, France
- Swaminathan R, Selvakumaran R, Esmy PO, et al (2009a). Cancer pattern and survival in a ural district in South India. Cancer Epidemiol, 33, 325-31. https://doi.org/10.1016/j.canep.2009.09.008
- Swaminathan R, Selvakumaran R, Vinodha J, et al (2009b). Education and cancer incidence in a rural population in south India. Cancer Epidemiol, 33, 89-93. https://doi.org/10.1016/j.canep.2009.06.012
- Teresa J, Brijesh S, Chacchu B, Chacko J (2011). Awareness of cervix cancer risk factors in educated youth: A crosssectional, questionnaire based survey in India, Nepal, and Sri Lanka. Asian Pac J Cancer Prev, 12, 1707-12.
- Varghese C, Amma NS, Chitrathara K, et al (1999). Risk factors for cervical dysplasia in Kerala, India. Bull World Health Organ, 77, 281-3.
- Wentzensen N, Schiffman M, Dunn ST, et al (2009). Grading the severity of cervical neoplasia based on combined histopathology, cytopathology, and HPV genotype distribution among 1,700 women referred to colposcopy in Oklahoma. Int J Cancer, 124, 964-9. https://doi.org/10.1002/ijc.23969
- Yeole BB (2008).Trends in cancer incidence in female breast, cervix uteri, corpus uteri, and ovary in India. Asian Pac J Cancer Prev, 9, 119-22.
- Comparison of Pap Smear Screening Results between Akha Hill Tribe and Urban Women in Chiang Rai Province, Thailand vol.13, pp.11, 2012, https://doi.org/10.7314/APJCP.2012.13.11.5501
- Nested Multiplex PCR Based Detection of Human Papillomavirus in Cervical Carcinoma Patients of North- East India vol.14, pp.2, 2013, https://doi.org/10.7314/APJCP.2013.14.2.785
- A Six-Year Study of the Clinical Presentation of Cervical Cancer and the Management Challenges Encountered at a State Teaching Hospital in Southeast Nigeria vol.7, pp.1179-5549, 2013, https://doi.org/10.4137/CMO.S12017
- Differencies in Risk Factors for Cervical Dysplasia with the Applied Diagnostic Method in Serbia vol.15, pp.16, 2014, https://doi.org/10.7314/APJCP.2014.15.16.6697
- Single Life Time Cytological Screening in High Risk Women as an Economical and Feasible Approach to Control Cervical Cancer in Developing Countries Like India vol.16, pp.3, 2015, https://doi.org/10.7314/APJCP.2015.16.3.859
- Socio-demographic and reproductive determinants of cervical neoplasia in seven sub-Sahara African countries vol.27, pp.12, 2016, https://doi.org/10.1007/s10552-016-0823-5
- Socio-Demographic, Reproductive and Clinical Profile of Women Diagnosed with Advanced Cervical Cancer in a Tertiary Care Institute of Delhi vol.67, pp.1, 2017, https://doi.org/10.1007/s13224-016-0907-x
- Strategies for reducing risk of cervical cancer in adolescents in developing countries – A view point vol.7, pp.1, 2016, https://doi.org/10.1016/j.injms.2015.10.003
- Cervical cancer awareness and presence of abnormal cytology among HIV-infected women on antiretroviral therapy in rural Andhra Pradesh, India pp.1758-1052, 2019, https://doi.org/10.1177/0956462419825950