RESUMO
Most low-resource settings depend on hormonal contraceptives for their family planning programmes and cervical cancer occurs in higher frequency in these populations. To determine whether hormonal contraception use increases cervical carcinoma in-situ (CIS) risk, a case-control study was conducted in the Kingston and St Andrew Corporate area of Jamaica, using 119 cases from the Jamaica Tumour Registry and 304 population controls matched on year of Papanicolaou (Pap) smear and clinic where Pap smear was obtained. While CIS cases were more likely to have 'ever used' combined oral contraceptives (COC) (OR = 1.4, 95% CI: 0.8, 2.5), depo-medroxyprogesterone acetate (DMPA) use was similar. Compared to women who never used hormonal contraceptives, the risk of CIS was elevated in: women who had used COCs five years or more (OR = 2.1, 95% CI: 1.0, 4.6), women who first used COC for less than 10 years prior to the interview (OR = 1.8, 95% CI: 0.9, 3.7) and women who were 18 to 24 years old when they first used COCs (OR = 1.8, 95% CI: 0.9, 3.4). Similarly, compared to women who never used DMPA, the risk of CIS was elevated in: women using DMPA five years or more (OR = 1.9, 95% CI: 0.7, 4.8), women reporting use within a year prior to interview (OR = 2.8, 95% CI: 0.7, 10.7) and women who initiated use of DMPA when they were 20 and 24 years old (OR = 1.4, 95% CI: 0.7, 3.1). These results suggest that if hormonal contraceptive use confers any risk of CIS, it is confined to long-term users. Increased risk in some groups, however, warrant further study.
Assuntos
Anticoncepcionais Femininos/efeitos adversos , Acetato de Medroxiprogesterona/efeitos adversos , Displasia do Colo do Útero/induzido quimicamente , Neoplasias do Colo do Útero/induzido quimicamente , Adolescente , Adulto , Estudos de Casos e Controles , Anticoncepcionais Orais Combinados , Feminino , Humanos , Jamaica/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Neoplasias do Colo do Útero/epidemiologia , Displasia do Colo do Útero/epidemiologiaRESUMO
Se realizó un estudio en 56 pacientes sexualmente activas que presentaban algún grado de neoplasia intraepitelial cervical (NIC). A cada una de las pacientes se les aplicó un cuestionario general por medio del cual pudimos conocer su historia sexual-reproductiva. El grupo en estudio estuvo constituido por 29 pacientes con uso de anticonceptivos orales (AO) y 27 pacientes consideradas como control, por no haber utilizado nunca este tipo de planificación familiar. A cada una de las pacientes se les realizó una valoración colposcópica, durante la cual se tomó una parte de la lesión para estudio histopatológico y la otra para valoración del receptor estrogénico (RE) presente. Se encontró que la frecuencia de RE en el tejido neoplásico de las pacientes con uso de anticonceptivos (CAO) no es estadísticamente significativa (P > 0.05), con respecto a las pacientes sin uso de anticonceptivos (SAO). De la misma manera, cuando se analizaron otros factores de riesgo como inicio de vida sexual activa, edad de la primera gesta, número de compañeros sexuales y número de gestas, se encontraron constantemente no significativos (P > 0.05) cuando se compararon las medias de ambos grupos. Por medio de este estudio, no hemos encontrado ninguna evidencia clara de alguna relación etiológica entre el uso de anticonceptivos orales y neoplasia intraepitelial cervical, sin embargo, se observa que la estimulación sobre la producción de RE en las etapas tempranas es evidente, probablemente por el estímulo estrogénico de procedencia exógena.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Displasia do Colo do Útero/induzido quimicamente , Anticoncepcionais Orais/efeitos adversos , Estradiol/efeitos adversos , Receptores de Estrogênio/análise , Colposcopia , Planejamento Familiar/métodos , Esfregaço VaginalRESUMO
OBJECTIVE: To determine, through the micronucleus (MN) test, the cytogenetic effects of cigarette smoking on exfoliated cells from the uterine cervix in women with normal smears and women with inflammatory atypia, squamous intraepithelial lesion (SIL) (cervical intraepithelial neoplasia [CIN] 1-3) and cervical cancer. STUDY DESIGN: The study group consisted of 200 women divided into three subgroups: group 1 (n = 116), women periodically undergoing cervical cytology and residents of Salvador-Bahia; group II (n = 57), women residing in São Paulo and previously selected because of a possible cytopathologic test positive for such conditions as human papillomavirus infections or malignant or premalignant cervical lesions (CIN 1-3); group III (n = 27), inmates of the Tatuapé Penal Institution, São Paulo. All the women underwent cytologic and colposcopic examination, and biopsies were performed on 68 of them. RESULTS: Considering the samples as a whole and using the chi(2) test for rare events, the number of MNs in smokers was significantly greater than in nonsmokers. It was also greater in women with larger exposure to smoking. The occurrence of MN was significantly lower in women with normal smears (smokers and nonsmokers) than in those showing any kind of pathologic alteration. In nonsmokers the occurrence of MN was similar between those with inflammatory atypia (IA) or low grade (L) SIL (CIN 1) and significantly higher in women with more severe lesions or high grade (H) SIL (CIN 2 and 3). Smokers with LSIL (CIN 1) showed a higher number of MNs than nonsmokers with a comparable diagnosis and smokers with IA. No differences were observed when compared with smokers with HSIL (CIN 2 and 3). MN occurrence was not associated with other risk factors for SIL or cancer development, such as age at first coitus, number of sexual partners, multiparity and use of hormonal contraceptives. CONCLUSION: These results suggest that the mutagenic effect of cigarette smoking occurs in cervical cells and that the progression of SIL is associated with increased frequency of chromosomal damage. Moreover, the data suggest that cigarette smoking introduces an additional risk to the progression of low grade LSIL (CIN 1). MN testing would be helpful in monitoring smokers with this kind of lesion.
PIP: Previous studies have shown that cigarette smoking increases the risk of developing squamous intraepithelial lesion (SIL) and cervical cancer. The present study used the micronucleus test to assess the cytogenic effects of smoking on exfoliated cells from 3 subgroups of Brazilian women: group 1 (n = 116), women periodically undergoing cervical cytology; group 2 (n = 57), women with a possibly positive cytologic test for human papillomavirus or malignant or premalignant cervical intraepithelial neoplasia (CIN 1-3); and group 3 (n = 27), inmates of the Tatuape Penal Institute. Overall, micronucleus frequency was significantly greater in smokers than in nonsmokers. The occurrence of micronuclei was significantly lower in women with normal smears (regardless of smoking status) than in women with any evidence of pathologic alterations. In nonsmokers, micronucleus frequency was similar in women with inflammatory atypia or low-grade CIN and significantly higher in women with more severe lesions and CIN 2-3. Smokers with CIN 1 had more micronuclei than nonsmokers with a comparable diagnosis and smokers with inflammatory atypia. No differences were observed in comparisons with smokers with CIN 2-3. Micronucleus occurrence was not associated with age at first coitus, number of sexual partners, multiparity, or use of hormonal contraception. These findings suggest that the mutagenic effect of smoking occurs in cervical cells and that SIL progression is associated with an increased frequency of chromosomal damage. The data further suggest that smoking adds to the risk of progression of low-grade SIL (CIN 1). Micronucleus testing, along with the cervical cytologic smear, is recommended to monitor smokers with this type of lesion.
Assuntos
Transformação Celular Neoplásica/induzido quimicamente , Colo do Útero/patologia , Fumar/efeitos adversos , Doenças do Colo do Útero/induzido quimicamente , Adulto , Brasil , Transformação Celular Neoplásica/patologia , Cocarcinogênese , Anticoncepcionais Orais Hormonais/efeitos adversos , Progressão da Doença , Células Epiteliais/química , Células Epiteliais/patologia , Feminino , Humanos , Metaplasia , Testes para Micronúcleos , Papillomaviridae , Infecções por Papillomavirus/epidemiologia , Prisioneiros , História Reprodutiva , Fatores de Risco , Comportamento Sexual/estatística & dados numéricos , Infecções Tumorais por Vírus/epidemiologia , Doenças do Colo do Útero/epidemiologia , Doenças do Colo do Útero/patologia , Displasia do Colo do Útero/induzido quimicamente , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Cervicite Uterina/epidemiologia , Cervicite Uterina/patologia , Esfregaço VaginalRESUMO
The authors refer to a 21-year-old Caucasian (white) woman, who in 1977 presented fever and cervical and axillary adenopathy, whose biopsy showed nodular sclerosis Hodgkin's Disease, stage IIIB. The patient received six chemotherapy cycles associated with immunotherapy and supplemented with radiation therapy with good response. RESULTS--In 1985, after routine gynaecological examination and a hysterectomy, cervical intraepithelial neoplasia grade 3 (CIN 3) and atypic leiomyoma of the uterine body were diagnosed. Five years later, biopsies diagnosed invasive duct carcinoma in the right breast and homolateral axillary and cervical nodes. The patient was submitted to chemo and radiation therapy and died nine months later. CONCLUSION--The possibility of later occurrence of a second or multiple new malignancies in patients successfully treated for Hodgkin's Disease points out the need for a more complete long-term follow-up, including periodic mammography.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/induzido quimicamente , Carcinoma Ductal de Mama/induzido quimicamente , Doença de Hodgkin/tratamento farmacológico , Leiomioma/induzido quimicamente , Segunda Neoplasia Primária/induzido quimicamente , Displasia do Colo do Útero/induzido quimicamente , Neoplasias Uterinas/induzido quimicamente , Adulto , Feminino , Humanos , Mecloretamina/administração & dosagem , Mecloretamina/efeitos adversos , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Procarbazina/administração & dosagem , Procarbazina/efeitos adversos , Indução de Remissão , Vincristina/administração & dosagem , Vincristina/efeitos adversosRESUMO
PIP: A comparative retrospective study of cervical lesions was conducted in Jalisco, Mexico. 154,784 cytologic studies were done; 36.7% of women observed used either hormonal contraception or the IUD. Dysplasia was found in 1.71/1000 women, but in 1.2/1000 of those using contraception. Incidence of carcinoma in situ was 1.97/1000 overall, but 1.84/1000 for women on contraception. Patients who used contraception, and who had either dysplasia or carcinoma, tended to be younger than patients who did not use contraception; the difference was 5 years for dysplasia, 10 for carcinoma in situ, and 16 for invasive carcinoma. To obtain more reliable data it would be necessary to conduct a perspective study, to augment the number of cases observed, and to prolong investigations for at least 5 years.^ieng