RESUMO
OBJECTIVES: To determine seroprevalence and determinants of herpes simplex virus 2 (HSV-2) seropositivity, in a random sample of a population based cohort of 10 049 women of Guanacaste, Costa Rica, using a highly sensitive and specific serological assay. METHODS: Seroprevalence was determined by a type specific HSV-2 ELISA assay in an age stratified random sample of 1100 women. Univariate and multivariate logistic regression was used to calculate odds ratios and 95% confidence intervals for risk factors of seropositivity. RESULTS: Overall age adjusted HSV-2 seroprevalence was 38.5% (95% CI, 37.5 to 39.5), and it was strongly associated with increasing age (p(Trend<0.0001)), both among monogamous women and women with multiple sexual partners. A greater number of lifetime sexual partners increased the risk of seropositivity, with a 28.2% (95% CI, 24.4 to 32.2) seroprevalence among monogamous women and 75% (95% CI, 65.6 to 83.0) seroprevalence for those with four or more partners (OR = 7.6 95% CI, 4.7 to 12.4 p(Trend<0.0001)). Barrier contraceptive use was negatively associated with HSV-2 seropositivity (OR 0.54, 95% CI, 0.31 to 0.94). Women with antibodies against HPV 16, 18, or 31 were 1.6 times more likely to be HSV-2 seropositive (OR 1.6, 95% CI, 1.2 to 2.1). CONCLUSIONS: HSV-2 infection is highly endemic in Guanacaste, even among lifetime monogamous women, suggesting a role of male behaviour in the transmission of the infection. Until vaccination against HSV-2 is available, education to prevent high risk sexual behaviour and the use of condoms appear as preventive measures against HSV-2.
Assuntos
Herpes Genital/epidemiologia , Herpesvirus Humano 2 , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Costa Rica/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Reação em Cadeia da Polimerase , Fatores de Risco , Saúde da População Rural , Estudos Soroepidemiológicos , Parceiros SexuaisRESUMO
In the time period January 1998-December 2000, a case-control study on squamous cell cancer of the oesophagus was conducted in Montevideo, Uruguay. The main objective of the study was to estimate the odds ratios (ORs) associated with main food groups. For this purpose, 166 patients afflicted with squamous cell oesophageal cancer and 664 hospitalised controls were frequency matched on age and sex. Both series of patients were administered with a structured questionnaire. Aside from queries related with tobacco smoking, alcohol drinking and maté drinking, patients were interviewed with a food-frequency questionnaire (FFQ) on 64 items, representative of the usual Uruguayan diet. Red meat, salted meat and boiled meat displayed strong direct associations (OR for red meat 2.4, 95% CI 1.4-4.2). On the other hand, fish and total white meat showed moderate protective effect (OR for total white meat 0.5, 95% CI 0.3-0.9). Total fruit intake displayed a strong inverse association (OR 0.2, 95% CI 0.1-0.4), whereas total vegetable consumption presented a weak inverse association (OR for total vegetable intake 0.7, 95% CI 0.4-1.2). These results suggest that vegetables, mainly cooked vegetables, are rich in thermolabile protective substances. On the other hand, boiled (stewed) meat, which is ingested at high temperature could be, like maté, a risk factor for squamous cell cancer of the oesophagus.
Assuntos
Carcinoma de Células Escamosas/epidemiologia , Neoplasias Esofágicas/epidemiologia , Comportamento Alimentar , Alimentos , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/prevenção & controle , Estudos de Casos e Controles , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/prevenção & controle , Feminino , Frutas , Humanos , Masculino , Carne , Pessoa de Meia-Idade , Razão de Chances , Plantas Comestíveis , Plantas Medicinais , Fatores de Risco , Fumar/efeitos adversos , Inquéritos e Questionários , Nicotiana , Uruguai/epidemiologia , VerdurasRESUMO
To estimate the effects of consuming hot beverages, including mate (an infusion of the herb Ilex paraguayensis), tea, coffee and coffee with milk, and other food items on esophageal cancer risk, we analyzed data from 830 cases and 1,779 controls participating in a series of 5 hospital-based case-control studies of squamous-cell carcinoma of the esophagus conducted in high-risk areas of South America. After adjusting for the strong effects of tobacco and alcohol consumption, both heavy mate drinking (>1 l/day) and self-reported very hot mate drinking were significantly associated with esophageal cancer risk in men and women. The magnitude and strength of the association for mate amount and, to a lesser extent, mate temperature were higher for women than men. The joint effects of mate amount and mate temperature were more than multiplicative, following a statistically significant synergistic interaction (p = 0.02) which was particularly evident among heavy drinkers (>1.50 l/day) of very hot mate (odds ratio = 4.14, 95% confidence interval: 2.24-7.67) compared to light drinkers (<0.50 l/day) of cold/warm/hot mate. Consumption of other very hot beverages, such as tea and coffee with milk but not coffee alone, was also significantly associated with an increased risk, in the 2- to 4-fold range. Statistically significant protective associations were identified for high consumption of vegetables, fruits, cereals and tea. In contrast, frequent consumption of meat, animal fats and salt was associated with a moderately increased risk. This pooled analysis adds evidence for a carcinogenic effect of chronic thermal injury in the esophagus induced by the consumption of very hot drinks, including mate. Our study further confirms the protective effect of a dietary pattern characterized by daily consumption of fruits and vegetables and low consumption of meat and animal fats.
Assuntos
Bebidas , Carcinoma de Células Escamosas/epidemiologia , Neoplasias Esofágicas/epidemiologia , Cônjuges , Idoso , Animais , Argentina/epidemiologia , Brasil/epidemiologia , Estudos de Casos e Controles , Dieta , Feminino , Temperatura Alta , Humanos , Magnoliopsida , Masculino , Pessoa de Meia-Idade , Leite , Paraguai/epidemiologia , Fatores de Risco , Fumar , América do Sul/epidemiologia , Uruguai/epidemiologiaRESUMO
To estimate the independent and joint effects of tobacco smoking and alcohol drinking, we analyzed data from a series of 5 hospital-based case-control studies of squamous-cell carcinoma of the esophagus conducted in high-risk areas in South America. A total of 830 case subjects and 1779 control subjects were included in the pooled analysis. All exposure characteristics of amount, duration, cessation and type of alcohol and tobacco consumed were strongly related to esophageal-cancer risk in both sexes. Women had the same exposure profile as men, but the magnitudes of the associations were lower than were those among men. Black-tobacco smoking was associated with a 2-fold increased risk as compared with the smoking of blond or mixed tobacco. Quitting either of the 2 habits significantly reduced esophageal-cancer risk. Alcohol and tobacco alone were strongly related to the risk of esophageal cancer, even in the absence of the other exposure. A history of simultaneous exposure to cigarette smoking and alcohol drinking had a strong multiplicative effect on risk. Concomitant exposure to heavy alcohol drinking and black-tobacco smoking identified the group with the highest risk for developing esophageal cancer (odds ratio = 107). A synergistic interaction was found between the 2 habits, particularly in women and in moderately exposed men. Moderate cigarette smoking without drinking and moderate alcohol drinking without smoking had a negligible effect on esophageal-cancer risk. However, simultaneous exposure to the same moderate amounts increased the risk 12- to 19-fold in men and in women respectively. The overall public-health implications of these findings are obvious for a tumor that depends on preventive strategies for its control.
Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Neoplasias Esofágicas/etiologia , Fumar/efeitos adversos , Adulto , Fatores Etários , Idoso , Argentina/epidemiologia , Brasil/epidemiologia , Estudos de Casos e Controles , Neoplasias Esofágicas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraguai/epidemiologia , Fatores de Risco , Uruguai/epidemiologiaRESUMO
To investigate the role of men in cervical cancer, 816 husbands of women enrolled in four case-control studies of cervical neoplasia in populations at high (Colombia) and low (Spain) risk for cervical cancer were interviewed. Exfoliated cells from the penis were obtained and analyzed by polymerase chain reaction for the presence of human papillomavirus (HPV) DNA. Penile HPV DNA prevalences were higher in husbands of women with cervical neoplasia than in husbands of controls. Husbands of controls in Colombia had a 5-fold higher penile HPV DNA prevalence than the corresponding husbands in Spain. Strong dose-response relationships were found between penile HPV DNA prevalence and all sexual behavior-related variables in Spain but not in Colombia. Sexual promiscuity is the most important risk factor for penile HPV infections. Differences in HPV DNA prevalence in the male populations of Spain and Colombia are consistent with their 8-fold difference in cervical cancer incidences.
Assuntos
DNA Viral/isolamento & purificação , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Pênis/virologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Estudos de Casos e Controles , Colo do Útero/virologia , Colômbia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , Espanha/epidemiologia , Cônjuges , Infecções Tumorais por Vírus/epidemiologiaRESUMO
BACKGROUND: Epidemiologic evidence has been inconclusive in linking men's sexual behavior and genital human papillomaviruses (HPVs) with cervical cancer risk in their sexual partners in areas with a high incidence of cervical cancer. PURPOSE: This study assesses the role of men's sexual behavior and the presence of penile HPV DNA on the risk of their wives' developing cervical neoplasia in an area in Colombia with a high incidence of cervical cancer. METHODS: A total of 210 husbands of women with cervical intraepithelial neoplasia grade III (n = 118) or invasive squamous cell carcinoma of the cervix (n = 92) and a total of 262 husbands of women recruited as control subjects (173 and 89, respectively) were interviewed. Questionnaires included detailed information on sexual behavior. Exfoliated cells were obtained from the glans penis and from the distal urethra of the penis. The specimens were analyzed for HPV DNA by use of a polymerase chain reaction-based assay that included a generic probe and 25 type-specific probes. Serum specimens were collected and analyzed for antibodies to Chlamydia trachomatis, Treponema pallidum, herpes simplex virus type II, and Neisseria gonorrhoeae. RESULTS: Limited education (adjusted odds ratio [OR] = 4.4; 95% confidence interval [CI] = 1.9-9.8; for no schooling versus secondary or higher education) and presence of antibodies to C. trachomatis (adjusted OR = 2.5; 95% CI = 1.5-4.4) in husbands were the only identified risk factors for cervical neoplasia in their wives. The prevalence of HPV DNA in the penis was 25.7% among husbands of case women and 18.9% among husbands of control women (adjusted OR = 1.2; 95% CI = 0.6-2.3). Neither the lifetime number of female sexual partners (adjusted OR = 1.0; 95% CI = 0.4-2.6; for > 50 partners versus one to five) nor the lifetime number of female prostitutes as sexual partners (adjusted OR = 1.2; 95% CI = 0.7-2.0; for > or = 21 prostitutes versus one to five) was associated with the risk of cervical cancer. CONCLUSIONS: Our results are compatible with the hypothesis that in the population of Cali, whose women are at high risk of developing cervical cancer, exposure to HPV among young men is a common occurrence and is mediated by contacts with large numbers of female sexual partners and prostitutes. These widespread sexual practices limit the power of case-control studies to detect significant associations between men's sexual behavior and the cervical cancer risk in their sexual partners. HPV DNA detection in the penis of adult men is a poor reflection of lifetime exposure or of etiologically relevant exposure to HPV. The role of C. trachomatis in cervical carcinogenesis deserves further investigation. IMPLICATIONS: Further research is needed to elucidate the male's role in cervical carcinogenesis in populations at high risk for cervical cancer. HPV DNA prevalence surveys and studies of the natural history of HPV in young men will be of great value.
Assuntos
DNA Viral/análise , Papillomaviridae/genética , Pênis/virologia , Comportamento Sexual , Neoplasias do Colo do Útero/virologia , Carcinoma de Células Escamosas/virologia , Estudos de Casos e Controles , Colômbia/epidemiologia , Feminino , Humanos , Incidência , Masculino , Análise Multivariada , Fatores de Risco , Neoplasias do Colo do Útero/epidemiologia , Displasia do Colo do Útero/virologiaRESUMO
A hospital-based case-control study, including 131 cases of esophageal cancer and 381 controls, was carried out in Paraguay to investigate the role of hot and cold mate drinking in esophageal cancer risk. Detailed information on mate drinking and on tobacco smoking, alcohol consumption, and dietary habits was obtained by interview. Amount and duration of cold or hot mate drinking were not associated with esophageal cancer risk. However, temperature at which mate was drunk was significantly associated with risk. As compared to drinkers of warm or hot mate, drinkers of very hot mate had an increased risk for esophageal cancer even after adjusting for the strong effects of alcohol and tobacco consumption (adjusted odds ratio = 2.4; 95% confidence interval = 1.3-4.3). This effect seemed to be mainly due to the temperature at which mate cocido (one of the two ways in which hot mate is prepared) was drunk (odds ratio = 6.5; 95% confidence interval = 3.2-12.2). As expected, very strong dose-response associations were found for alcohol consumption and cigarette smoking. After correcting for these and the consumption of other food groups, diets rich in fats and red meats, especially beef, were associated with esophageal cancer risk. In conclusion, the findings from this study suggest that cold mate drinking does not increase the risk of esophageal cancer. This study identifies the very hot temperature at which mate is drunk, and not the amount or the duration, as an important risk factor for esophageal cancer in this population. Alcohol drinking and tobacco smoking remain, nevertheless, the main risk factors for esophageal cancer in Paraguay.
Assuntos
Bebidas/efeitos adversos , Neoplasias Esofágicas/etiologia , Comportamento Alimentar , Magnoliopsida/efeitos adversos , Adulto , Distribuição por Idade , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Estudos de Casos e Controles , Temperatura Baixa , Intervalos de Confiança , Neoplasias Esofágicas/epidemiologia , Feminino , Temperatura Alta , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Paraguai/epidemiologia , Análise de Regressão , Fatores de Risco , Distribuição por Sexo , Fumar/efeitos adversosRESUMO
To study the role of hot mate drinking, alcohol, tobacco, and diet in esophageal cancer, a case-control study including 131 cases and 262 hospital controls was carried out in La Plata, Argentina. In multivariate analyses, statistically significant increases in risk were detected for alcohol, tobacco, and some dietary factors but not for hot mate drinking. A strong dose-response relationship was observed with the amount of alcohol consumed daily but not with the number of cigarettes smoked. The odds ratio for those drinking more than 200 ml of ethanol/day compared to nondrinkers was 5.7 (95% confidence interval, 2.2-15.2). An increased risk was also observed for those eating barbecued meat more than once a week (odds ratio, 2.4; 95% confidence interval, 1.2-4.8) as compared to those eating it less than once a week, and a reduction in risk was associated with daily consumption of nonbarbecued beef as compared to those eating it less than daily. Concerning mate drinking, the only variable that showed an effect was the temperature at which mate is drunk. Those who reported drinking mate hot or very hot as compared to those drinking it warm had an increase in risk (odds ratio, 1.7; 95% confidence interval, 1.0-2.9). Our findings strengthen the evidence for an important role of alcohol and tobacco in esophageal carcinogenesis but do not provide strong support for a role of hot mate drinking.
Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Bebidas/efeitos adversos , Carcinoma de Células Escamosas/etiologia , Neoplasias Esofágicas/etiologia , Comportamento Alimentar , Fumar/efeitos adversos , Idoso , Argentina/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Intervalos de Confiança , Estudos Transversais , Relação Dose-Resposta a Droga , Neoplasias Esofágicas/epidemiologia , Feminino , Temperatura Alta/efeitos adversos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de RiscoRESUMO
The risk of cervical cancer for a woman depends largely on the probability of being infected with some specific types of Human Papillomavirus (HPV). In the control groups of four case-control studies in Colombia and Spain we have shown a strong correlation between the number of sexual partners of males and females and HPV DNA prevalence in the genital tract. Our results suggest that the lifetime number of sexual partners in both sexes are surrogates of the probability of HPV infection and, as such, insufficiently explain the geographical variation in the incidence of cervical cancer. It is proposed that the high rates of cervical cancer in Latin America are linked to the largely unknown characteristics of the HPV endemicity in the population and to the absence of widespread screening for cervical neoplasia. Reliable surveys on the HPV prevalences in selected social groups (i.e., young males and prostitutes) as well as in populations in countries at different risk of cervical cancer are required.
Assuntos
Papillomaviridae/fisiologia , Infecções por Papillomavirus/epidemiologia , Comportamento Sexual , Infecções Tumorais por Vírus/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Carcinoma de Células Escamosas/epidemiologia , Estudos de Casos e Controles , Colômbia/epidemiologia , DNA Viral/genética , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/transmissão , Fatores de Risco , Trabalho Sexual , Parceiros Sexuais , Espanha/epidemiologia , Infecções Tumorais por Vírus/transmissão , Displasia do Colo do Útero/epidemiologiaRESUMO
In order to provide a reliable diagnosis for the presence and type of human papillomavirus (HPV) DNA in a case-control study of cervical cancer in Colombia and Spain, 926 cervical scrapes from female subjects were examined by ViraPap (VP) and Southern hybridization (SH), and 510 of these (263 cases and 247 controls) were also tested by polymerase chain reaction (PCR) using the HPV L1 consensus primers. HPV DNA prevalence was much higher in cases than in controls by each of the three tests. There was complete agreement between the results of the three tests for 64.9% of the 510 specimens; 53.5% were negative and 11.4% were positive (regardless of type) by all tests. An additional 29.0% of the specimens were positive by PCR: 19.4% by PCR alone, 6.7% by PCR and VP, and 2.9% by PCR and SH. SH and/or VP gave positive results for 6.0% of the specimens for which the PCR finding was negative: 2.7% by SH alone, 2.5% by VP alone, and 0.8% by both VP and SH. When specimens which were positive by VP alone or only by SH at low-stringency conditions were excluded, PCR confirmed all but four specimens which were positive by other tests. The concordance between type-specific diagnosis by SH and PCR was 86% when HPVs were typed in both tests. HPV-16 accounted for over 80% of the typed HPVs in each test. The presence of blood in case specimens did not appear to inhibit HPV positivity by VP or by PCR at the dilution tested. Low amounts of cellular DNA of specimens resulted in some underestimation of HPV positivity by VP and SH but not by PCR. Compared with that of PCR, the sensitivities for case specimens were 38% by SH and 50% by VP; the sensitivity for control specimens, although it could not be measured precisely because there were few positive specimens, appeared to be lower than for case specimens. It was concluded that PCR-based tests are best suited for epidemiological investigation of HPVs.