Tabagismo, infecção pelo papilomavirus humano e o desenvolvimento de neoplasia intra-epitelial cervical
Renata Guarisi
TESE
Português
(Broch.)
T/UNICAMP G931t
[Smoking, human Papilomavirus infection and the development of Cervical intraepithelial Neoplasia]
Campinas, SP : [s.n.], 2008.
117p. : il.
Orientadores: Luis Otavio Zanatta Sarian, Sophie Françoise Mauricette Derchain
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Resumo: Objetivo: Avaliar os efeitos do tabagismo na prevalência da infecção pelo papilomavírus humano de alto risco oncogênico (HR-HPV) e neoplasia intra-epitelial cervical (NIC). Avaliar prospectivamente os efeitos do tabagismo sobre a aquisição de HR-HPV e desenvolvimento de NIC em mulheres sem...
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Resumo: Objetivo: Avaliar os efeitos do tabagismo na prevalência da infecção pelo papilomavírus humano de alto risco oncogênico (HR-HPV) e neoplasia intra-epitelial cervical (NIC). Avaliar prospectivamente os efeitos do tabagismo sobre a aquisição de HR-HPV e desenvolvimento de NIC em mulheres sem lesão histológica na primeira consulta. Sujeitos e métodos: Foram avaliadas 12.114 mulheres incluídas no estudo Latin American Screening (LAMS) entre janeiro de 2002 a novembro de 2003, em Campinas, São Paulo, Porto Alegre e Buenos Aires. Foram formados três grupos: 1) não tabagistas (n=7.499), tabagistas (n=2.706) e 3) ex-tabagistas (n=1.871). Para o seguimento prospectivo de 36 meses foram selecionadas mulheres com pelo menos um exame alterado na primeira consulta, mas que não tinham lesão histológica, e 10% daquelas com todos os exames normais, totalizando 1.011 mulheres. Um grupo formado por 150 mulheres com citologia compatível com células escamosas atípicas (ASC) ou lesão intra-epitelial de baixo grau (LSIL) e colposcopia normal foi estudado separadamente. A análise inicial avaliou a relação entre a história de tabagismo e outros fatores epidemiológicos com a prevalência de infecção por HR-HPV e NIC. As mulheres foram examinadas a cada seis meses com colposcopia, captura de híbridos 2 e colpocitologia oncológica. Resultados: A diferença mais importante entre os grupos foi a prevalência de HR-HPV entre tabagistas (21,7%) quando comparadas a não tabagistas (16,5%) e ex-tabagistas (13,5%). Teste HR-HPV positivo (OR=9,69; 95%CI=5-18,79), citologia com lesão intra-epitelial de alto grau (OR=40,52; 95%CI = 8,52-192,6) e história de não ter realizado Papanicolaou no passado (OR=2,65; 95%CI=1,21- 5,79) estiveram associados ao maior risco de NIC 2 ou pior na consulta inicial. A incidência de anormalidades no Papanicolaou durante o seguimento foi mais freqüente nas tabagistas (5,8%) quando comparadas às ex-tabagistas (4,8%) e não tabagistas (1,7%). Durante o seguimento, HR-HPV+ na consulta inicial aumentou significativamente o risco de incidência de Papanicolaou anormal, independentemente da história de tabagismo. Tabagismo foi um significante preditor de incidência de HR-HPV durante o seguimento, e ter HR-HPV+ na consulta inicial, ser tabagista e ex-tabagista foram fatores de risco independentes para incidência de NIC2 ou pior. No grupo ASC/LSIL, apenas HR-HPV + inicial esteve associado ao risco de
desenvolver NIC durante o seguimento de 36 meses (HR=3,42; 95CI%=1,11-9,43). Mulheres tabagistas tiveram maior risco de NIC de alto grau ou câncer durante o seguimento, quando comparadas às não tabagistas (p=0,04). Conclusões: O tabagismo, no passado ou presente, esteve associado a maior prevalência de infecção por HPV de alto risco oncogênico. O tabagismo também esteve associado ao aumento de risco de desenvolvimento de NIC 2 ou pior em mulheres com infecção por HPV de alto risco oncogênico. O tabagismo aumenta o risco de desenvolvimento de NIC2 ou pior em mulheres com citologia ASC/LSIL e
colposcopia normal, em um período de 36 meses Ver menos
desenvolver NIC durante o seguimento de 36 meses (HR=3,42; 95CI%=1,11-9,43). Mulheres tabagistas tiveram maior risco de NIC de alto grau ou câncer durante o seguimento, quando comparadas às não tabagistas (p=0,04). Conclusões: O tabagismo, no passado ou presente, esteve associado a maior prevalência de infecção por HPV de alto risco oncogênico. O tabagismo também esteve associado ao aumento de risco de desenvolvimento de NIC 2 ou pior em mulheres com infecção por HPV de alto risco oncogênico. O tabagismo aumenta o risco de desenvolvimento de NIC2 ou pior em mulheres com citologia ASC/LSIL e
colposcopia normal, em um período de 36 meses Ver menos
Abstract: Objective: To assess whether smoking history interferes with the prevalence of hr-HPV infection and cervical intraepithelial neoplasia (CIN) and to prospectively examine the acquisition of hr-HPV infection and the development of CIN in
baseline normal women. Subjects and methods: The study... Ver mais Abstract: Objective: To assess whether smoking history interferes with the prevalence of hr-HPV infection and cervical intraepithelial neoplasia (CIN) and to prospectively examine the acquisition of hr-HPV infection and the development of CIN in
baseline normal women. Subjects and methods: The study examines the baseline data on 12,114 women included in the Latin American Screening (LAMS) Study in São Paulo, Campinas, Porto Alegre and Buenos Aires, and the prospective data from 1,011 women, that included women with at least one positive test at baseline and no histological lesion and 10% of the women with normal cytology; and 150 women with ASC/LSIL and normal colposcopy at baseline, followed-up for a period of 36 months. Three groups were formed: 1) women that never smoked (n=7.499), 2) current (n=2.706) and 3) past smokers (n=1.871). The baseline assessment included the relation between the smoking history and several other epidemiological factors with the prevalence of hr-HPV infection and CIN. In the prospective analysis, women were controlled at 6-month intervals with colposcopy, HC2 and Pap to assess the cumulative risk of incident hr-HPV infection, smear abnormalities and CIN over a period of 36 months. Results: The most important significant differences were the higher prevalence (21.7%) of HR-HPV infections among current smokers as compared to women who never smoked (16.5%) or those smoking in the past (13.5%). Testing HR-HPV positive at baseline (OR=9.69; 95%CI=5-18.79), high-grade squamous intraepithelial lesion in baseline Pap smear (OR=40.52; 95%CI = 8.52-192.6) and history of no previous Pap smear (OR=2.65; 95%CI=1.21-5.79) were significant predictors of baseline CIN2 or worse. Among women with baseline abnormal Pap, progression to CIN2or or worse was substantially more frequent in current (5.8%) and past smokers (4.8%) than in never smokers (1.7%). During follow-up, testing HR-HPV+ at baseline significantly increased the risk of incident abnormal Pap, irrespective of the smoking status. Being a current smoker was a significant predictor of incident HR-HPV during the follow-up (HR =1.44; 95%CI 1.03-2.04), and, baseline HR-HPV+ (HR=10.07; 95%CI 1.32-76.49), being a past smoker (HR=3.61; 95%CI 1.06-12.33) and current smoker (HR=3.51; 95%CI 1.21-10.14) for incident CIN2 or worse. Among women with ASC/LSIL at baseline, the HR-HPV+ (HR = 3.42; 95%CI 1.11 to 9.43) was the only factor related to an increased risk of developing CIN during the 36-month followup. While restricting the analysis to high-grade CIN, the probability of developing the disease was significantly higher for smokers (p= 0.04). Conclusion: The smoking history, past or current, was related to a higher prevalence of HR-HPV, and to a increased risk of developing CIN2 or worse in women with HR-HPV+. Being smoker was related to a higher risk of developing CIN2 or worse in women with baseline ASC/LSIL and normal colposcopy, during 36-months follow-u Ver menos
baseline normal women. Subjects and methods: The study... Ver mais Abstract: Objective: To assess whether smoking history interferes with the prevalence of hr-HPV infection and cervical intraepithelial neoplasia (CIN) and to prospectively examine the acquisition of hr-HPV infection and the development of CIN in
baseline normal women. Subjects and methods: The study examines the baseline data on 12,114 women included in the Latin American Screening (LAMS) Study in São Paulo, Campinas, Porto Alegre and Buenos Aires, and the prospective data from 1,011 women, that included women with at least one positive test at baseline and no histological lesion and 10% of the women with normal cytology; and 150 women with ASC/LSIL and normal colposcopy at baseline, followed-up for a period of 36 months. Three groups were formed: 1) women that never smoked (n=7.499), 2) current (n=2.706) and 3) past smokers (n=1.871). The baseline assessment included the relation between the smoking history and several other epidemiological factors with the prevalence of hr-HPV infection and CIN. In the prospective analysis, women were controlled at 6-month intervals with colposcopy, HC2 and Pap to assess the cumulative risk of incident hr-HPV infection, smear abnormalities and CIN over a period of 36 months. Results: The most important significant differences were the higher prevalence (21.7%) of HR-HPV infections among current smokers as compared to women who never smoked (16.5%) or those smoking in the past (13.5%). Testing HR-HPV positive at baseline (OR=9.69; 95%CI=5-18.79), high-grade squamous intraepithelial lesion in baseline Pap smear (OR=40.52; 95%CI = 8.52-192.6) and history of no previous Pap smear (OR=2.65; 95%CI=1.21-5.79) were significant predictors of baseline CIN2 or worse. Among women with baseline abnormal Pap, progression to CIN2or or worse was substantially more frequent in current (5.8%) and past smokers (4.8%) than in never smokers (1.7%). During follow-up, testing HR-HPV+ at baseline significantly increased the risk of incident abnormal Pap, irrespective of the smoking status. Being a current smoker was a significant predictor of incident HR-HPV during the follow-up (HR =1.44; 95%CI 1.03-2.04), and, baseline HR-HPV+ (HR=10.07; 95%CI 1.32-76.49), being a past smoker (HR=3.61; 95%CI 1.06-12.33) and current smoker (HR=3.51; 95%CI 1.21-10.14) for incident CIN2 or worse. Among women with ASC/LSIL at baseline, the HR-HPV+ (HR = 3.42; 95%CI 1.11 to 9.43) was the only factor related to an increased risk of developing CIN during the 36-month followup. While restricting the analysis to high-grade CIN, the probability of developing the disease was significantly higher for smokers (p= 0.04). Conclusion: The smoking history, past or current, was related to a higher prevalence of HR-HPV, and to a increased risk of developing CIN2 or worse in women with HR-HPV+. Being smoker was related to a higher risk of developing CIN2 or worse in women with baseline ASC/LSIL and normal colposcopy, during 36-months follow-u Ver menos
Sarian, Luís Otávio Zanatta, 1974-
Orientador
Pinto-Neto, Aarão Mendes, 1952-2015
Avaliador
Zeferino, Luiz Carlos, 1955-
Avaliador
Carvalho, Jesus de Paula
Avaliador
Andrade, Jurandyr Moreira de
Avaliador
Tabagismo, infecção pelo papilomavirus humano e o desenvolvimento de neoplasia intra-epitelial cervical
Renata Guarisi
Tabagismo, infecção pelo papilomavirus humano e o desenvolvimento de neoplasia intra-epitelial cervical
Renata Guarisi
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