© 1997 by Oxford University Press
Journal Of The National Cancer Institute, Vol 89, 1516-1523, Copyright © 1997 by Oxford University Press
MM Madeleine, JR Daling, JJ Carter, GC Wipf, SM Schwartz, B McKnight, RJ Kurman, AM Beckmann, ME Hagensee and DA Galloway
BACKGROUND: Human papillomavirus (HPV) has been previously associated with
vulvar cancer. In a population-based study, we examined whether exposure to
HPV, cigarette smoking, or herpes simplex virus 2 (HSV2) increases the risk
of this cancer. METHODS: Incident cases of in situ (n = 400) and invasive
(n = 110) squamous cell vulvar cancer diagnosed among women living in the
Seattle area from 1980 through 1994 were identified. Serum samples were
analyzed for antibodies against specific HPV types and HSV2. HPV DNA in
tumor tissue was detected by means of the polymerase chain reaction. In
most analyses, case subjects were compared with population-based control
subjects (n = 1403). Relative risks of developing vulvar cancer were
estimated by use of adjusted odds ratios (ORs) and 95% confidence intervals
(CIs). RESULTS: Increased risks of in situ or invasive vulvar cancer were
associated with HPV16 seropositivity (ORs = 3.6 [95% CI = 2.6-4.8] and 2.8
[95% CI = 1.7-4.7], respectively), current cigarette smoking (ORs = 6.4
[95% CI = 4.4-9.3] and 3.0 [95% CI = 1.7-5.3], respectively), and HSV2
seropositivity (ORs = 1.9 [95% CI = 1.4-2.6] and 1.5 [95% CI = 0.9- 2.6],
respectively). When the analysis was restricted to HPV16 DNA- positive
tumors (in situ or invasive), the OR associated with HPV16 seropositivity
was 4.5 (95% CI = 3.0-6.8). The OR for vulvar cancer was 18.8 (95% CI =
11.9-29.8) among current smokers who were HPV16 seropositive in comparison
with never smokers who were HPV16 seronegative. CONCLUSIONS: Current
smoking, infection with HPV16, and infection with HSV2 are risk factors for
vulvar cancer. Risk appears particularly strong among women who are both
current smokers and HPV16 seropositive.
ARTICLES
Cofactors with human papillomavirus in a population-based study of vulvar cancer [published erratum appears in J Natl Cancer Inst 1997 Dec 17;89(24):1896]
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98104-2092, USA.
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