Socioeconomic status and the risk of cervical intraepithelial neoplasia grade 3 among oncogenic human papillomavirus DNA-positive women with equivocal or mildly abnormal cytology

Authors

  • Michelle J. Khan B.A.,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville Maryland
    2. HHMI–NIH Research Scholars Program, Howard Hughes Medical Institute, Chevy Chase, Maryland
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  • Edward E. Partridge M.D.,

    Corresponding author
    1. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
    • Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 618 South 20th Street, Birmingham, AL 35233
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    • Fax: (205) 975-6174

  • Sophia S. Wang Ph.D.,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville Maryland
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  • Mark Schiffman M.D., M.P.H.,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville Maryland
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  • Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study (ALTS) Group

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    • The Atypical Squamous Cells of Undetermined Significance (ASCUS)-Low Grade Squamous Intraepithelial Lesion (LSIL) Triage Study (ALTS) Group Coauthors: National Cancer Institute, Bethesda, MD (D. Solomon, Project Officer; M. Schiffman, Coproject Officer; R. Tarone, Statistician); ALTS Clinical Centers: University of Alabama at Birmingham, Birmingham, AL (E. E. Partridge, Principal Investigator; L. Kilgore, Coprincipal Investigator; S. Hester, Study Manager); University of Oklahoma, Oklahoma City, OK (J. L. Walker, Principal Investigator; G. A. Johnson, Coprincipal Investigator; A. Yadack, Study Manager); Magee-Womens Hospital of the University of Pittsburgh Medical Center Health System, Pittsburgh, PA (R. S. Guido, Principal Investigator; K. McIntyre-Seltman, Coprincipal Investigator; R. P. Edwards, Investigator; J. Gruss, Study Manager); University of Washington, Seattle, WA (N. B. Kiviat, Coprincipal Investigator; L. Koutsky, Coprincipal Investigator; C. Mao, Investigator); Colposcopy Quality Control Group (D. Ferris, Principal Investigator, Medical College of Georgia, Augusta, GA; J. T. Cox, Coinvestigator, University of California at Santa Barbara, Santa Barbara, CA; L. Burke, Coinvestigator, Beth Israel Deaconess Medical Center Hospital, Boston, MA); HPV Quality Control Group (C. M. Wheeler, Principal Investigator, University of New Mexico Health Sciences Center, Albuquerque, NM; C. Peyton-Goodall, Laboratory Manager, University of New Mexico Health Sciences Center, Albuquerque, NM; M. M. Manos, Coinvestigator, Kaiser Permanente, Oakland, CA); Pathology Quality Control Group (R J Kurman, Principal Investigator, Johns Hopkins Hospital, Baltimore, MD; D. L. Rosenthal, Coinvestigator, Johns Hopkins Hospital, Baltimore, MD; M. E. Sherman, Coinvestigator, The National Cancer Institute, Rockville, MD; M. H. Stoler, Coinvestigator, University of Virginia Health Science Center, Charlottesville, VA); Westat, Coordinating Unit, Rockville, MD (J. Rosenthal, Project Director; M. Dunn, Data Management Team Leader; J. Quarantillo, Senior Systems Analyst; D. Robinson, Clinical Center Coordinator); Quality of Life Group (D. M. Harper, Chair of ALTS Quality of Life Group, Dartmouth Medical School, NH); Digene Corporation, Gaithersburg, MD (A. T. Lorincz, Senior Scientific Officer); and Information Management Services, Inc., Silver Spring, MD (B. Kramer, Senior Programmer/Analyst).


  • This article is a US Government work and, as such, is in the public domain.

  • Some of the equipment and supplies used in this study were donated or provided at reduced cost by Digene Corporation (Gaithersburg, MD), Cytyc Corporation (Boxborough, MA), National Testing Laboratories (Fenton, MO), Denvu (Tucson, AZ), TriPath Imaging, Inc. (Burlington, NC), and Roche Molecular Systems Inc. (Alameda, CA).

Abstract

BACKGROUND

Low socioeconomic status (SES) is a reported risk factor for cervical carcinoma, but few studies have taken into account adequately the possibly confounding effects of oncogenic human papillomavirus (HPV) infection as well as access to screening and subsequent treatment.

METHODS

Women (n = 5060 women) with a mean age of 27.5 years and with equivocal or mild cytologic cervical abnormalities were enrolled in the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion (ASCUS-LSIL) Triage Study (ALTS), a clinical trial that evaluated management strategies. The women were seen every 6 months for 2 years. The enrollment questionnaire assessed three indicators of SES: race/ethnicity, education, and source of payment for medical care. Multivariate logistic regression models were used to identify predictors of oncogenic HPV DNA positivity at enrollment and to assess associations between the SES indicators and risk of cervical intraepithelial neoplasia grade 3 (precancer) and carcinoma (≥ CIN3) identified throughout the study (n = 506 women) among oncogenic HPV-positive women (n = 3133 women).

RESULTS

SES indicators were not associated significantly with oncogenic HPV infection after adjustment for age at enrollment, recent and lifetime number of sexual partners, study center, and smoking history. Among women with oncogenic HPV, the risk of ≥ CIN3 increased with decreasing education (less than high school education: odds ratio [OR], 2.4; 95% confidence interval [95%CI], 1.5–3.7 vs. completed college). Black women (OR, 0.5; 95%CI, 0.4–0.7) and white/Hispanic women (OR, 0.4; 95%CI, 0.2–0.8) were at decreased risk for ≥ CIN3 compared with white/non-Hispanic women. The source of payment for medical care was not associated with risk.

CONCLUSIONS

Factors associated with lower SES, such as low education, may serve as a surrogate for unknown factors that influence progression to ≥ CIN3 among women with oncogenic HPV infection. In this controlled setting with equalized follow-up and treatment, the decreased risk of ≥ CIN3 associated with black and white/Hispanic race/ethnicity could be further examined. Ongoing efforts should emphasize methods for equalizing screening and follow-up among women of varying SES, regardless of race or ethnicity. Cancer 2005. Published 2005 American Cancer Society.

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