© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 2, 156-162,
January 20, 1999
© 1999 Oxford University Press
Human Papillomavirus Infection and Esophageal Cancer: a Nationwide Seroepidemiologic Case-Control Study in Sweden
Affiliations of authors: J. Lagergren, Department of Medical Epidemiology and Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Z. Wang, Microbiology and Tumor Biology Center, Karolinska Institutet; R. Bergström, Department of Medical Epidemiology, Karolinska Institutet, and Department of Statistics, Uppsala University, Sweden; J. Dillner, Microbiology and Tumor Biology Center, Karolinska Institutet; O. Nyrén, Department of Medical Epidemiology, Karolinska Institutet.
Correspondence to: Jesper Lagergren, M.D., Department of Medical Epidemiology, Karolinska Institutet, Box 281, S-171 77 Stockholm, Sweden (e-mail: Jesper.Lagergren{at}mep.ki.se).
BACKGROUND: Infection with human papillomavirus (HPV) type 16 has been implicated as a risk factor for esophageal squamous cell carcinoma in three seroepidemiologic studies. We conducted a larger, population-based study to verify this association and to investigate possible confounding factors. METHODS: We performed a nationwide case-control study in Sweden of HPV16 or HPV18 infection and risk of esophageal squamous cell carcinoma or esophageal/gastroesophageal adenocarcinoma. Tumors were strictly classified by their location and histologic type. Case subjects with incident cancers and population-based control subjects donated blood samples and were interviewed in person about potential confounding factors. An enzyme-linked immunosorbent assay was used to detect HPV seropositivity. Multivariate analyses were conducted to study relationships between HPV seropositivity, level of education, smoking (all tobacco) status, alcohol consumption, and cancer risk. RESULTS: We compared 121 case subjects with esophageal squamous cell carcinoma and 173 case subjects with adenocarcinoma of the esophagus or gastroesophageal junction with 302 population-based control subjects. The age- and sex-adjusted odds ratios (ORs) for squamous cell carcinoma were 1.0 (95% confidence interval [CI] = 0.5-2.0) for persons seropositive for HPV16 and 0.5 (95% CI = 0.2-1.1) for persons seropositive for HPV18 in comparison with seronegative individuals. The corresponding ORs for adenocarcinoma were 1.2 (95% CI = 0.7-2.2) and 0.2 (95% CI = 0.1-0.7), respectively. Adjustments for smoking status, alcohol consumption, and level of education did not alter the results. CONCLUSIONS: We found no evidence of a positive association between HPV16 or HPV18 infection and either form of esophageal cancer. Our results do not support conclusions from previous studies.
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