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Research Article Open Access

Cervical Cancer: Sociodemographic and Clinical Risk Factors among Adult

Egyptian Females
El-Moselhy EA1,3*, Borg HM2 and Atlam SA1,3
1
Professor of Clinical Epidemiology, Community Medicine Department, Faculty of Medicine, Al-Azhazr University, Egypt
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta University, Egypt
3
Lecturer of Community Medicine, Department of Community Medicine, Faculty of Medicine, Tanta University, Egypt

Abstract
Background: Cervical cancer is an important health problem world-wide. Low socioeconomic status, no
screening attendance, smoking, Oral Contraceptives (OCs) usage, multiparous, and sexual multi-partners are
important risk factors.
Aim: To determine the sociodemographic and clinical risk factors of cervical cancer among Egyptian women.
Patients and methods: Eighty six adult females with cervical cancer and 200 adult healthy females were
recruited as the cases and controls. A case-control study design was used in this research. A comprehensive
interviewing form was used to collect data.
Results: Significant sociodemographic risk factors were low education, low occupation, and age ≥50 (OR=3.42,
4.79, 3.35; respectively). Also, significant sexual behavior risk factors were premarital sexual practice, practice
with STDs symptomatic partner, none circumcised partner, and ≥3 life time sexual partners (OR=5.36, 3.1, 12.28,
26.25; respectively). Meanwhile, significant gynecological and reproductive risk factors were age at marriage <18,
age at first full term labor <20, multiparity >5, vaginal delivery, and OCs usage (OR=2.63, 2.06, 2.19, 11.86, 4.93;
respectively). Significant medical and family history risk factors were obesity, history of STDs, and positive family
history of cervical cancer (OR=5.42, 4.44, 14.93; respectively). Significant life style risk factors were low fruits and
vegetables intake, passive smoker, alcohol use, and poor genital hygiene (OR=7.04, 10.23, 4.34, 2.36; respectively).
Conclusions and recommendations: Risk factors of cervical cancer are mostly preventable. More studies
should be conducted on big number of patients in different areas to understand the true epidemiology and situation
of cervical cancer in Egypt and to doubling of efforts to address high-risk groups. Also, the need for a national
prevention and control program, the integration of screen services into health facilities that women use.

Keywords: Cervical cancer; Risk factors; Sociodemographic; marriage, extramarital sexual activity, premarital sexual activity, early
Clinical; Egypt age at first pregnancy, multiple sexual partners of the women and
husbands, and uncircumcised sexual partners [7].
Introduction
A number of important epidemiological risk factors have been
Cervical cancer is an important health problem world-wide, being identified as early age at marriage, coitus before the age of 18 years,
the second most common cancer among women, ranking first in multiple sexual partner, delivery of the first baby before the age of 20
many developing countries [1]; about 80.0% of total cases are present years, multiparty with poor birth spacing between pregnancies, and
in developing countries [2]. It was once, one of the most common poor personal hygiene [8]. Women with Sexually Transmitted Diseases
causes of cancer death. Over the last 30 years, the cervical cancer death (STDs) like HIV infection, herpes simplex virus 2, and Human
rate has gone down by more than 50.0% for American women. The Papilloma Virus (HPV) infection [8,9]. Other factors associated with
main reason for this change was the increased use of the Pap test [3]. increased risk are smoking, Oral Contraceptives (OCs) and lack of
Preventable cases of cervical cancer in developed countries such as UK some nutritional factors like beta-carotene, vitamin C, and low intake
are 100.0% [4]. of fruits [10].
Low socioeconomic status, prostitution, and urban residence were Negligence by patient of initial symptoms like leucorrhoea, post-
observed more common among females with cervical cancer [5]. The coital bleeding; unawareness of symptoms, illiteracy, and lack of
increased risk with low socioeconomic status is attributed mainly to the adequate screening facilities are increase incidence among women [11].
non-attendance of screening, and by consequence failure of treating
precancerous lesions, and to the lack of knowledge about prevention
*Corresponding author: El-Moselhy EA, Department of public Health and
of infections. Most of women with cervical cancer experience a long Community Medicine, Al-Azhar University, Egypt, Tel: 002-01006317065; E-mail:
asymptomatic period before the disease clinically onset. Regular dr_elmoselhy@yahoo.com
screening offers early detection against progression from pre invasive Received March 08, 2016; Accepted April 26, 2016; Published May 06, 2016
to invasive stage [6].
Citation: El-Moselhy EA, Borg HM, Atlam SA (2016) Cervical Cancer:
Epidemiological studies have shown an increased risk for cervical Sociodemographic and Clinical Risk Factors among Adult Egyptian Females. Adv
Oncol Res Treat 1: 106.
cancer attributable to sexual and reproductive behavior [6]. Cervical
cancer was almost unknown in nuns; it has been thought that sexual Copyright: © 2016 El-Moselhy EA, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
activity is a major factor in cervical cancer genesis. Other related factors unrestricted use, distribution, and reproduction in any medium, provided the
associated with cervical cancer include early age at first coitus, multiple original author and source are credited.

Adv Oncol Res Treat, an open access journal Volume 1 • Issue 1 • 1000106
 Citation: El-Moselhy EA, Borg HM, Atlam SA (2016) Cervical Cancer: Sociodemographic and Clinical Risk Factors among Adult Egyptian Females.
Adv Oncol Res Treat 1: 106.

Page 2 of 7

Aim of the Study explained to the patients and controls. Consents of both of them were
given before starting the field work and confidentiality and security
The aim of this study is to determine the sociodemographic, were guaranteed.
gynecological, obstetrics, reproductive, life style, and health care
behavior risk factors for cervical cancer among Egyptian women in Statistical analysis
Assiut Governorate.
Odds Ratio (OR) test was used to detect the risk factors. To
Patients and Methods determine the significance of OR the 95% Confidence Interval (CI) or
Exact Confidence Limits (ECL) was used.
Study design
Results
An analytic, case-control, clinic-based study design was chosen to
perform this research. Table 1 clears significant sociodemographic risk factors for
cervical cancer are lowest education level (illiterate and read and write)
Administrative design [OR=3.42, 95% CI: 1.93-6.07], lowest occupation level (unskilled labor)
Required approvals to conduct the study in the hospitals were [OR=4.79, 95% CI: 2.46-9.37], low social class [OR=2.2, 95% CI: 1.27-
obtained before starting the field work. 3.81], higher age (≥50 years) [OR=3.35, 95% CI: 1.83-6.15], and rural
residence [OR=1.95, 95% CI: 1.11-3.42].
Study settings and patients
Table 2 illustrates significant sexual behavior risk factors for
Eighty six adult female patients with cervical cancer attending cervical cancer are premarital sexual practice [OR=5.36, 95% CI:
Gynecology Clinics, Al-Hussein and Tanta University Hospitals for 1.93-15.37], practice with STDs symptomatic partner [OR=3.11, 95%
follow up were recruited as a patients group in this study. Two hundred CI: 1.14-8.56], none circumcised partner [OR=12.28, 95% ECL: 1.33-
apparently normal female adults (relatives to other patients attending 583.82], and number of life time sexual partners 2 [OR=2.81, 95% CI:
the clinic and free from cervical cancer) were enrolled in the study as 1.21-6.54] and ≥3 [OR=26.25, 95% ECL: 8.62-105.4].
controls. Both the patients and controls were females and their age
range, 35-71 years. Table 3 reports significant gynecological and reproductive risk
factors for cervical cancer are young age at marriage (<18 years)
Study tools [OR=2.63, 95% CI: 1.44-4.83], age at first full term labor (<20 years)
[OR=2.06, 95% CI: 1.12-3.79], grand multiparity (>5) [OR=2.19, 95%
A specially designed comprehensive interviewing form contains
CI: 1.21-4.0], vaginal delivery [OR=11.86, 95% ECL: 1.85-494.47],
data relevant to the topic of study was used. Also, all the patients and
birth spacing <2 years [OR=2.13, 95% CI: 1.09-4.21], and OCs usage
the controls had undergone anthropometric measurements; height
[OR=4.93, 95% ECL: 1.16-44.15] for >5 years [OR=2.86, 95% CI: 1.62-
(cm) and weight (kg) were measured with participants standing
5.07].
without shoes and heavy outer garments and accordingly Body Mass
Index (BMI) was calculated and classified according to WHO [12]. Table 4 shows significant medical and family history risk factors for
cervical cancer are obesity (BMI ≥30) [OR=5.42, 95% CI: 3.03-9.74],
Ethical consideration history STDs [OR=4.44, 95% CI: 1.93-10.35], genital warts [OR=12.28,
The study was approved by Ethics Committees in Al-zhar and 95% ECL: 1.33-583.82], genital herpes [OR=4.34, 95% ECL: 1.06-
Tanta University. The purpose of the study and procedures were 20.68], positive family of history cervical cancer [OR=14.93, 95% ECL:

Sociodemographic risk factors Patients (n=86) Controls (n=86) OR* (95%CI)**

No. % No. %
Educational level
Illiterate and read and write 59 68.6 78 39.0 3.42 (1.93-6.07)
Elementary 18 20.9 48 24.0 0.84 (0.43-1.61)
Secondary and university 9 10.5 74 37.0 0.2 (0.09-0.44)
Occupational level
House wife 16 18.6 68 34.0 0.44 (0.23-0.85)
Unskilled 32 37.2 22 11.0 4.79 (2.46-9.37)
Semi-skilled and skilled 28 32.6 68 34.0 0.94 (0.53-1.66)
Professional 10 11.6 42 21.0 0.49 (0.22-1.09)
Social class
Low 52 60.5 82 41.0 2.2 (1.27-3.81)
Middle 24 27.9 58 29.0 0.95 (0.52-1.72)
High 10 11.6 60 30.0 0.31 (0.14-0.66)
Age (years)
<40 19 22.1 76 38.0 0.46 (0.25-0.86)
40-49 32 37.2 90 45.0 0.72 (0.42-1.26)
≥50 35 40.7 34 17.0 3.35 (1.83-6.15)
Residence
Urban 50 58.1 146 73.0 0.51 (0.29-0.9)
Rural 36 41.9 54 27.0 1.95 (1.11-3.42)
Table 1: Distribution of the studied females with cervical cancer and control group according to sociodemographic risk factors.

Adv Oncol Res Treat, an open access journal Volume 1 • Issue 1 • 1000106
 Citation: El-Moselhy EA, Borg HM, Atlam SA (2016) Cervical Cancer: Sociodemographic and Clinical Risk Factors among Adult Egyptian Females.
Adv Oncol Res Treat 1: 106.

Page 3 of 7

Sexual behavior risk factors Patients (n=86) Controls (n=200) OR* (95% CI)**
No. % No. % OR (95% ECL)***
Premarital sexual practice
Yes 14 16.3 7 3.5 5.36 (1.93-15.37)
Practice with STDs symptomatic partner
Yes 11 12.8 9 4.5 3.11 (1.14-8.56)
None circumcised partner
Yes 5 4.7 1 0.5 12.28 (1.33-583.82)*
Number of lifetime sexual partners
1 41 47.7 182 91.0 0.09 (0.04-0.18)
2 15 17.4 14 7.0 2.81 (1.21-6.54)
≥3 30 34.9 4 2.0 26.25 (8.62-105-4)*
*
Odds ratio. **Confidence intervals. ***Exact confidence limits.
Table 2: Distribution of the studied females with cervical and control group according to the sexual behavior risk factors.

Gynecological and reproductive history risk factors Patients (n=86) Controls (n=200) OR* (95%CI)**
No. % No. % OR (95% ECL)***
Age at marriage
<18 28 32.6 38 19.0 2.63 (1.44-4.83)
≥18 58 67.4 162 81.0 0.38 (0.21-069)
Age at first full term labor:
<20 years 28 32.6 38 19.0 2.06 (1.12-3.79)
≥20 years 58 67.4 162 81.0 0.49 (0.26-0.9)
Parity
0 3 3.5 18 9.0 0.37 (0.07-1.31)*
1-5 19 22.1 68 34.0 0.55 (0.29-1.03)
>5 64 74.4 114 57.0 2.19 (1.21-4.0)
Mode of delivery: (n=83) (n=182)
Normal vaginal 82 98.8 159 87.4 11.86 (1.85-494.47)*
Cesarean section 1 1.2 23 12.6 0.38 (0.21-069)
Birth spacing: (n=83) (n=182)
<2 years 71 82.6 138 69.0 2.13 (1.09-4.21)
Oral contraceptives (OCs) usage
Yes 84 97.7 179 89.5 4.93 (1.16-44.15)*
Duration of OCs use: (n=84) (n=179)
≤ 5 years 31 36.9 112 62.6 0.35 (0.2-0.62)
>5 ears 53 63.1 67 37.4 2.86 (1.62-5.07)
*
Odds ratio. **Confidence intervals. ***Exact confidence limits.
Table 3: Distribution of females with cervical cancer and control group according to gynecological and reproductive history risk factors.

Medical and family history risk factors Patients (n=86) Controls (n=200) OR* (95% CI)**
No. % No. % OR (95% ECL)***
Obesity (BMI, kg/ m²):
Normal <25 24 27.9 94 47.0 0.44 (0.24-0.78)
Pre-obese 25- 29.9 28 32.6 62 31.0 1.07 (0.6-1.91)
Obese ≥30 52 60.5 44 22.0 5.42 (3.03-9.74)
History of STDs:
Yes: 19 22.1 12 6.0 4.44 (1.93-10.35)
Genital warts (GW) 5 5.8 1 0.5 12.28 (1.33-583.82)*
Genital herpes (GH) 7 8.1 4 2.0 4.34 (1.06-20.68)*
Trichomonas vaginalis 7 8.1 7 3.5 2.44 (0.74-8.06)
Positive family history of cervical cancer
Yes 6 5.8 1 0.5 14.93 (1.75-689.83)*
1 degree relative (mother, sister)
st
5 4.7 1 0.5 12.28 (1.33-583.82)*
2nd and 3rd degree relatives 1 1.2 0 0.0 Undefined
Positive family history of other cancers type
Yes 3 3.5 1 0.5 7.19 (0.56-379.44)*
*
Odds ratio. **Confidence intervals. ***Exact confidence limits.
Table 4: Distribution of females with cervical cancer and control group according to the associated medical and family history risk factors.

Adv Oncol Res Treat, an open access journal Volume 1 • Issue 1 • 1000106
 Citation: El-Moselhy EA, Borg HM, Atlam SA (2016) Cervical Cancer: Sociodemographic and Clinical Risk Factors among Adult Egyptian Females.
Adv Oncol Res Treat 1: 106.

Page 4 of 7

1.75-583.82], and 1st degree relatives with cervical cancer [OR=12.28, result is agreement with Irimie et al. [6]; 33.3% of patients had a poor
95% ECL: 1.33-583.82]. economic condition and only 20.0% of them had good socioeconomic
status. Also, 7.3% and 23.7% of patients have a low and high level of
Table 5 clarifies significant life style risk factors for cervical cancer
education, respectively. On the other hand, Mhaske et al. [15] reported
are low intake of fruits and vegetables [OR=7.04, 95% CI: 3.48-14.37],
socioeconomic status was found to be statistically non-significant.
passive and ex-smoker [OR=10.23, 95% ECL: 3.14-52.46 and OR=2.49,
95% CI: 1.4-4.44; respectively], alcohol use [OR=4.34, 95% ECL: 1.06- In the present study we showed old age is a significant risk factor.
20.68], low physical activity [OR=2.03, 95% CI: 1.17-3.52], and poor Cervical cancer tends to occur in midlife. Most cases are found in
genital hygiene [OR=2.36, 95% CI: 1.34-4.15]. women younger than 50 years. It rarely develops in women younger
than 20 years. Older women do not realize that the risk of developing
Discussion cervical cancer is still present as they age. More than 15.0% of cervical
The association noticed between cervical cancer and low cancer cases are found in women over 65 [3]. In Egypt, prevalence of
socioeconomic level likely relates to poor cervical screening the disease is very low for those below 35 years but significantly increase
attendance and unhealthy life style. Income and education influence above that age [16]. Also, Irimie et al. [6] cleared the mean age in their
the access to proper early detection and treatment of precancerous patients was 49.96±11.74 with range 23- 74 years.
conditions [6]. Health care disparities arise from a complex interplay In this study we observed rural residence is a significant risk factor.
of economic, social, and cultural factors [13]. Further, socioeconomic In Egypt there is still persistent gap regarding socioeconomic status
factors influence other risk factors for cancer like tobacco use, poor between rural and urban settings. The inhabitants from rural areas
nutrition, physical inactivity, and obesity. Usually, poor and minority facing large problems of poverty and a more difficult access to health
communities are targeted by the marketing strategies of tobacco care services. Irimie et al. [6] showed 66.7% of their cervical cancer
companies, and they also may have limited access to healthy nutrition, patients were residents in rural area.
or recreational physical activity [6].
In the current study we reported early age at marriage, premarital
In the present study we showed low education and occupation sexual practice, non-circumcised partner, and ≥3 lifetime sexual
levels are significant risk factors. Health problems of women from partners were significant risk factors. Our results consistent with
low resources settings are often linked to excessive workload along Herrero et al. [17] and Piper [5]; they cleared young age at first
with a low level of education [6]. Also, percentage of incident cervical intercourse and high numbers of sexual partners have consistently
cancer cases in the UK in 2010 due to occupation was 0.7% [4]. On the emerged as significant risk factors for cervical cancer. However,
other hand, a lower risk was associated with higher level of education; these appear to be linked with sexual behavior and the acquisition of
7.3% and 23.7% of patients have a low and high level of education, HPV; none being consistently shown as a significant independent risk
respectively [6]. factor [18]. Also, Piper [5] reported the association between cervical
In the current study we cleared low socioeconomic level is a cancer and early age at first intercourse as biological activity in the
significant risk factor. Cervical cancer is more common in poor people cervical cell is at a maximal level during adolescence. Further, Spriggs
with low socioeconomic class than in the high socioeconomic. Low [19] assumed; firstly cell might be more susceptible to carcinogenic
socioeconomic status may exert its effect through poor sexual hygiene, transformation by early coital experience and secondly the multiplicity
multiparity, or early age of first coitus. The incidence by at least of of sexual partners. Furthermore, epidemiological studies show that
3-fold was occurring in the wives of the lower social classes [14]. In the there is a strong correlation with multiple partners. Also, the result
US, Hispanic women are most likely to get cervical cancer, followed by of this study is compatible with Reid et al. [7]; they proposed sperm
African-Americans, Asians and Pacific Islanders, and whites [3]. Our act as the carcinogen in cervical cancer. They found two basic types of

Life style risk factors Patients (n=86) Controls (n=200) OR* (95% CI)**
No. % No. % OR (95% ECL)***
Low fruits and vegetables intake
Yes 42 48.8 17 34.0 7.04 (3.48-14.37)
Tobacco smoking
Never smoke 18 20.9 92 46.0 0.31 (0.16-0.58)
Passive smoker 83 96.5 146 73.0 10.23 (3.14-52.46)*
Ex-smoker 61 70.9 99 49.5 2.49 (1.4-4.44)
Current smoker 7 8.1 9 4.5 1.88 (0.61-5.75)
Alcohol use
Yes 7 8.1 4 2.0 4.34 (1.06-20.68)*
Physical activity
Low 42 48.8 64 32.0 2.03 (1.17-3.52)
Genital hygiene
Poor 39 45.3 52 26.0 2.36 (1.34-4.15)
Negligence of initial symptoms:
Yes 84 97.7 182 91.0 4.15 (0.96-37.6)*
History of Pap smears testing:
No 85 98.8 194 97.0 2.63 (0.31-122.32)*
*
Odds ratio. **Confidence intervals. ***Exact confidence limits.
Table 5: Distribution of females with cervical cancer and control group according to the life style risk factors.

Adv Oncol Res Treat, an open access journal Volume 1 • Issue 1 • 1000106
 Citation: El-Moselhy EA, Borg HM, Atlam SA (2016) Cervical Cancer: Sociodemographic and Clinical Risk Factors among Adult Egyptian Females.
Adv Oncol Res Treat 1: 106.

Page 5 of 7

protein; histone and protamine in the ejaculate of human sperm. They cervical cancer. This agrees with Skegg et al. [14] and Mustafa [29].
believe that these basic proteins found in the sperm head particularly These women were exposed to more cervix trauma during normal
the protamines; might have a role in the etiology of cervical carcinoma. vaginal delivery especially multipara women with low socioeconomic
They showed in tissue culture that sperm can actually penetrate normal class.
mammalian cells particularly cervical metaplastic epithelium. While,
In this study we clarify history of Sexually Transmitted Diseases
Harris et al. [20] clarifies the well-known correlation with early age at
(STDs) is risk factor for cervical cancer. Cancer Research UK [4]
first coitus and at first pregnancy have been disappear when correction
reported percent of incident cervical cancer cases in the UK in 2010
is made for the number of partners. Further, more than 40.0% of
due to STDs was 1.0%. Also, 10.0% of cervical cancer cases linked to
patients have become sexually active before the age of 18, and 66.7%
HPV infection in. HPV is classified as a cause of cervical cancer [30].
and 33.3% of patients had one and >1 sexual partners, respectively
All cervical cancers in the UK are linked to HPV [31]. HPV infection
during lifetime. The majority of patients’ life partners had affirmatively
is common, but it progresses to cervical cancer in a minority of cases
multiple partners during lifetime, which increases the risk of acquiring
[32]. Around 12.0% of women without cervical abnormalities in the
HPV infection [6]. A significant association between age at marriage
UK and Ireland are infected with high-risk HPV types [33]. Fewer
(<17 years) and age at first childbirth (<20 years) and cervical cancer
than 10.0% of persistent HPV infections progress to carcinoma in situ
was reported [15]. Lastly, regarding circumcised partners, Spriggs [19],
[34], which left untreated, can progress to cervical cancer [32]. Cervical
noticed cervical cancer might be induced by smegma, lake of hygiene
cancer risk is higher in women with Genital Warts (GWs) versus those
or by some mutagenic factor in sperm head. Male circumcision is
without; though GWs are usually caused by low-risk HPV types, co-
an Islamic tradition among Egyptians; all Muslims and majority of
infection with high-risk HPV types is likely [35]. Meanwhile, in this
Christian’s follow.
study trichomonas infection is significant as risk factor for cervical
In the present study we illustrated age at first full term labor, ≥4 cancer. Our result agrees with De Carneri [36], who reported cervical
parity, vaginal delivery, OCs use, and ≥5 years OCs use were significant cancer and precancerous state are more frequent in women with
risk factors. Our results consistent with Dutta et al. [21]; they cleared trichomonasis. The role of trichomonasis has been emphasized by the
relative risk of acquiring disease was 6-fold more in cases of women presence of significantly higher antibody titer against trichomonas
who had first parity before age 18 years compared to those who had vaginalis in patients with cervical carcinoma. On the other hand, our
first parity after the age of 18 years (p<0.001). Also, Mhaske et al. [15] result not agrees with Mustafa [29].
noticed, among women with cancer, 19.2% had their first child before
In the current study we cleared obesity is risk factor for cervical
20 years of age and 9.5% ≥20 with statistically significant difference.
cancer. Obesity has been found associated with cervical adenocarcinoma.
Meanwhile, we observed high parity (≥4) is significant risk factor for
It appears that through its hormonal actions, obesity might play a role
cervical cancer. High parity had consistently emerged as significant
in cervical adenocarcinoma pathogenesis; adipose tissue being an
risk factor for cervical cancer [17]. The association was strongest for
active endocrine and metabolic organ with possible far-reaching effects
women with seven or more full term pregnancies [22]. Also, significant
on the physiology of other tissues [37]. Also, a strong, graded, inverse
association between high parity (>4) and cervical cancer was reported
relationship between BMI and the likelihood of undergoing screening
[15]. Further, our result agrees with Skegg et al. [14] and Munoz
for cervical cancer was demonstrated [38]. Obese women tend to delay
[22]; they reported a significant association between high parity and
medical care, especially Pap smear screen, as a result of a negative self-
increased risk of cervical cancer. Also, Irimie et al. [6] showed 37.5% of
perception, associated with embarrassment, or because wanting to
their patients had ≥3 childbirth. In the present study, we reported OCs
avoid weight loss advice [39]. Obesity represents not only a risk factor,
usage is significant risk factor for cervical cancer. Oral contraceptives
but also may affect prognosis through numerous pathways, including
(OCs) has been shown to increase the risk of cervical cancer, some
associated adverse disease features, co morbidities that can interfere
epidemiologic studies have suggested an increased risk or a shorter
with treatment, hormonal influences, and other mechanisms [6].
time of transition from dysplasia to carcinoma in situ [6]. Our finding
is in agreement with Vessey et al. [23], they suggested OCs usage might In the present study we noticed positive cervical cancer family
encourage sexual promiscuity and increase the exposure to carcinogenic history is risk factor. It is well recognized that cancer aggregated in
agents but they also commented that the mitotic inhibitory effect of families, first degree relatives of a cancer patient having an increased
oral OCs on the cervical epithelium may offset this. On the other hand, risk of same or different site cancers. For some cancers it was noticed a
our result does not agree with Valents and Hanjani [24]; they reported 2-3 fold increase in risk for those with a positive family history as against
OCs has not been shown clearly to increase the risk of cervical cancer. general population [40], but it is not yet clear if the risk associated with
While, evidence showed that long-term use of oral contraceptives (≥ 5) family history of cancer is due to a genetic susceptibility, or to shared
may be associated with an increased risk of cervical cancer [25]. Also, environmental and life style influences [41]. It has been documented
a review of the research has shown that women positive for HPV who that women with a family history of cervical cancer, especially in
have been used OCs for ≥10 are 2.5-fold as likely as never- users to first degree relatives, have a 2-fold risk of developing cervical cancer,
develop cervical cancer [26]. Further, HPV positive women who had suggesting an inherited susceptibility [42]. A positive familial history
ever used OCs were 1.5-fold more likely to develop cervical cancer of cervical cancer was found among 13.3% of the patients; the youngest
than controls. Women who used OCs for 5-9 years had significant patient had a positive cervical cancer history in a first-degree relative
association with cervical cancer [27]. Endocervical adenocarcinoma (mother) [6].
has been also associated with OCs in a number of patients, especially
In this study we found smoking represent significant risk factor for
those with prolonged used [28]. Also, 10.0% of cervical cancer cases
cervical cancer. This result is in agreement with Lyon et al. [43]; they
linked to the use of OCs in UK [4]. Further, 31.4% of patients in a
cleared increased risk of cervical cancer among smokers compared
sample in Romania have used OCs, but no one of these patients used
with non-smokers. Also, the mechanism by which cigarette smoking
for a longer than 5 years period of time [6].
leads to increase risk of cervical neoplastic is not known. It may
In the current study we cleared vaginal delivery is risk factor for act independently or may promote neoplastic transformation by

Adv Oncol Res Treat, an open access journal Volume 1 • Issue 1 • 1000106
 Citation: El-Moselhy EA, Borg HM, Atlam SA (2016) Cervical Cancer: Sociodemographic and Clinical Risk Factors among Adult Egyptian Females.
Adv Oncol Res Treat 1: 106.

Page 6 of 7

interfering with normal host defense mechanisms. Further, Brintion et 9. Kjaer SK, Villiers EM, Haugaard BJ, Christensen RB, Teisen C, et al. (2005)
Human papillomavirus, herpes simplex virus and cervical cancer incidence
al. [44] showed cotinine, micotione, and other mutagens are found in
in Greenland and Denmark- A population based cross-sectional study. Int J
cervical mucus of smokers, which could support a direct carcinogenic Cancer 4: 518-24.
effect.
10. Schiffman M (2006) Cancer Epidemiology and Prevention. In: David
In the current study we cleared no Pap screen is risk factor for Schottenfeld and Joseph F Fraumeni Jr. (3rdedn) Oxford University Press.
cervical cancer. Patient who unawareness of symptoms or neglect initial 11. Howkins J, Bourne G (1999) Gynecological diagnosis. Shaw’s textbook of
symptoms like leucorrhoea, post-coital bleeding, etc and lack adequate gynecology, (13thedn) New Delhi, Churchill Livingstone, India.
screening facilities is at risk for increased incidence of cervical cancer 12. WHO (2000) Obesity: preventing and managing the global epidemic. WHO
[11]. Cervical cancer rarely occurs in women who have been getting Technical Report Series, Geneva.
regular tests to screen for it before they were 65 [3]. Data document 13. Freeman HP (2003) Commentary on the meaning of race in science and
a very low rate of participation in cervical screening programs; 61.1% society. Cancer Epidemiol Biomark Prev 12: 232S-236S.
of patients had never been screened for cervical cancer. Patients who 14. Skegg DC, Crowin PA, Paul C (2003) Importance of the male factor of cancer
reported being screened annually or at two years interval were: younger cervix. Lancet 362: 583-9.
ages, lean, residents in urban area, high level of education, and good 15. Mhaske MS, Jawadekar SJ, Saundale SG (2011) Study of associated of
socio-economic status [6]. Further, we found poor intake of fruits and some risk factors and cervical dysplasia/cancer among rural women. Nat J
vegetables is risk factor for cervical cancer. Health problems of women Community Med 2: 209-212.
in developing countries are often linked to nutritional deficiencies [6]. 16. Hammad MMA, Jones HW, Zayed M (1987) Low prevalence of cervical
intraepithelial neoplasia among Egyptian females. Oncol 28: 300-304.
This result is in accordance with Schiffman et al. [10]; they stated
lack of some nutritional factors like beta-carotene, vitamin C, and low 17. Herrero R, Brinton LA, Reeves WC, Brenes MM, Tenorio F, et al. (1990) Sexual
behavior, venereal diseases, hygiene practices, and invasive cervical cancer in
intake of fruits increased the risk of cervical cancer. Also, we observed a high risk population. Cancer 65: 380-386.
poor personal sexual hygiene is significant risk factor for cervical
18. Khan MJ, Partridge EE, Wang SS, Schiffman M (2005) Socioeconomic status
cancer. Our result is agreed with WHO [8] and Skegg et al. [14];
and the risk of cervical intraepithelial neoplasia grade 3 among oncogenic
showed the same finding. human papillomavirus DNA-positive women with equivocal or mildly abnormal
cytology. Cancer 104: 61-70.
Conclusions and Recommendations
19. Spriggs AL (2000) Natural history of cervical dysplasia. Clinics Obstet Gynecol
Significant sociodemographic risk factors were low education and 81: 79.
occupation, and age ≥50 years. Significant sexual behavior risk factors 20. Harris RWC, Brinton LA, Cowdell RH, Doll R (2003) Characteristics of women
were premarital sexual practice, practice with STDs symptomatic with dysplasia or carcinoma in situ of the cervix uteri. Br J Cancer 42: 359-369.
partner, none circumcised partner, and ≥3 life time sexual partners. 21. Dutta P, Upadhay A, Dutta M, Urmil AC, Thergaonkar MP, et al. (1990) A case
Significant gynecological and reproductive risk factors were age at control study of cancer cervix patients attending command hospital, Pune.
marriage <18, age at first full term labor <20, multiparity >5, vaginal Indian J Cancer 27: 101-108.
delivery, and OCs usage. Significant medical and family history risk 22. Munoz N (2002) Role parity and human papilloma virus in cancer: The IARC.
factors were obesity, history of STDs, and positive family history of Multicentric case control study. Lancet 359: 1093-1101.
cervical cancer. Significant life style risk factors were low intake of fruits 23. Vessey MP, Mepherson K, Lawless M (2002) Neoplasia of the cervix uteri and
and vegetables, passive smoker, alcohol use, and poor genital hygiene. contraception, a possible adverse effect of the pill. Lancet 359: 930-932.
To identify the public health importance of cervical cancer in Egypt, 24. Valents PT and Hanjani P (1996) Endocervical neoplasia in long-term uses
more studies are needed; large community based studies with larger of oral contraceptions: Clinical and pathologic observations. Obstet Gynecol
samples. More studies should be conducted on big number of patients 67: 695.
in different areas to understand the true epidemiology and situation of 25. Smith JS, Green J, Berrington de Gonzalez A, Appleby P, Peto J, et al. (2003)
cervical cancer in Egypt and to doubling of efforts to address high-risk Cervical cancer and use of hormonal contraceptives: A systematic review.
Lancet 361: 1159-1167.
groups. Also, the need for a national prevention and control program,
the integration of screen services into health facilities that women use. 26. IARC Handbooks of Cancer Prevention (2005) Cervix Cancer Screening
Volume 10. Lyon: 2005.
References
27. Moreno V, Bosch FX, Muñoz N, Meijer CJ, Shah KV, et al. (2002) Effect of oral
1. Garcia AA (2006) Cervical cancer screening. Am J Obstet Gnecol 155: 139-44. contraceptives on risk of cervical cancer in women with human papillomavirus
infection: The IARC multicentric case-control study. Lancet 359: 1085-1092.
2. Kishore J (2007) National Health Programs of India. (7thedn) New Delhi,
Century Publication, India. 28. Shields TS, Falk RT, Herrero R (2007) A case-control study of oral contraceptive
and cervical cancer. Br J Cancer 90: 146.
3. The American Cancer Society (2014) Cancer Statistics Center: Cervical cancer.
29. Mustafa FA (2007) Cervical lesions and early detection of cancer cervix
4. Cancer Research UK (2016) Cervical cancer incidence statistics. Cancer
in Assiut Governorate. MD Thesis, Obstetrics and Gynecology, Faculty of
Research UK.
Medicine, Al-Azhar University.
5. Piper JM (2002) Oral contraceptive and cervical cancer. Gynecol Oncol 22:
30. IARC (International Agency for Research on Cancer) (2011) List of
1-18.
classifications by cancer sites with sufficient or limited evidence in humans.
6. Irimie S, Vladd M, Mirestean IM, Balacescu O, Rus M, et al. (2011) Risk factors
31. Parkin DM, Boyd L, Walker LC (2011) The fraction of cancer attributable to
in a sample of patients with advanced cervical cancer. Appl Med Informatics
lifestyle and environmental factors in the UK in 2010. Br J Cancer 105: S77-S81.
29: 1-10.
32. Kulasingam SL, Havrilesky L, Ghebre R, Myers ER (2011) Screening for
7. Reid BL, French PW, Singer A (2001) Sperm basic proteins in cervical
cervical cancer: a decision analysis for the U.S. preventive services task force.
carcinogenesis correlation with socioeconomic class. Lancet 356: 60-65.
Rockville (MD): Agency for Healthcare Research and Quality (US).
8. WHO (2002) Cervical cancer screening in developing countries. WHO report,
33. Anderson L, O’Rorke M, Jamison J, Wilson R, Gavin A; HPV Working Group
Geneva, 3-5.
members (2013) Prevalence of human papilloma virus in women attending

Adv Oncol Res Treat, an open access journal Volume 1 • Issue 1 • 1000106
Citation: El-Moselhy EA, Borg HM, Atlam SA (2016) Cervical Cancer: Sociodemographic and Clinical Risk Factors among Adult Egyptian Females.
Adv Oncol Res Treat 1: 106.

Page 7 of 7

cervical screening in the UK and Ireland: new data from Northern Ireland and a 39. Wee CC, McCarthy EP, Davis RB, Phillips RS (2000) Screening for cervical
systematic review and meta-analysis. J Med Virol 85: 295-308. and breast cancer: is obesity an unrecognized barrier to preventive care? Ann
Intern Med 132: 697-704.
34. Rositch AF, Koshiol J, Hudgens MG (2013) Patterns of persistent genital
human papilloma virus infection among women worldwide: a literature review 40. Peto J and Houlston RS (2001) Genetics and the common cancers. Eur J
and meta-analysis. Int J Cancer 133: 1271-1285. Cancer 37: S88-S96.
35. Blomberg M, Friis S, Munk C, Bautz A, Kjaer SK (2012) Genital warts and risk 41. Risch N (2001) The genetic epidemiology of cancer: interpreting family and
of cancer: a Danish study of nearly 50 000 patients with genital warts. J Infect twin studies and their implications for molecular genetics approaches. Cancer
Dis 205: 1544-1553. Epidemiol Biomarkers Prev 10: 733-741.
36. De Carneri DI (2000) Vaginal trichomoniasis and precaneous state of the 42. Negri E, La Vecchia C, Bosetti C, Franceschi S, Parazzini F (2005) Risk of
cervix: A preliminary report. J Obstet Gynecol 77: 10-16.
cervical cancer in women with a family history of breast and female genital tract
37. Lacey JV Jr, Swanson CA, Brinton LA, Altekruse SF, Barnes WA, et al. (2003) neoplasm. Int J Cancer 117: 880-881.
Obesity as a potential risk factor for adenocarcinomas and squamous cell
carcinomas of the uterine cervix. Cancer 98: 814-821. 43. Lyon LI, Chrdner WT, West WD, et al. (1997) Smoking and carcinoma in situ of
the uterine cavity. Am J Publ Health 73: 558-565.
38. Maruthur NM, Bolen SD, Frederick L. Brancati FL, Clark JM (2008) The
association of obesity and cervical cancer screening: a systematic review and 44. Brintion LA, Schairer C, Haenszel W (1999) Cigarette smoking and invasive
meta-analysis. Obesity 17: 375-381. cervical cancer. JAMA 255: 3265-3270.

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