Cervical Cancer Risk Factors Association in Patients at the Gynecologic-Oncology Clinic of Dr. Soetomo Hospital Surabaya

Aisyiah Rahmi Putri* -  Faculty of Medicine, Airlangga University, Surabaya, Indonesia
Siti Khaerunnisa -  Department of Medical Biochemistry, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
Indra Yuliati -  Department of Obstetrics and Gynecology, Dr. Soetomo Hospital, Surabaya, Indonesia

DOI : 10.33371/ijoc.v13i4.610

Background: Cervical cancer ranks fourth of all cancers in women worldwide and linked to human papillomavirus (HPV) infection. Despite the evidence of methods for cervical cancer prevention, such as pap smear test and HPV vaccination, most of the women remain unscreened and never get HPV vaccination. Most cervical cancer cases are not diagnosed early enough, leading to poor outcomes. This study aims to examine the association of risk factors with cervical cancer incidence in Dr. Soetomo Hospital Surabaya and also records the patients’ knowledge of cervical cancer preventions, history of HPV vaccination, and pap smear screening test.

Methods: This is a case-control study. Questionnaires were given to 60 newly diagnosed cervical cancer patients and 60 non-cervical cancer patients at The Gynecologic-Oncology Clinic of Dr. Soetomo Hospital Surabaya in the period of March 2016 until August 2016. The analysis was made using bivariate and multivariate logistic regression analysis.

Results: The bivariate logistic regression analysis confirmed that parity more than two times (p=0.001), history of birth control pills consumption more than 10 years (p=0.04), passive smoking (p=0.001) and not knowing that cervical cancer can be prevented (p=0.001) were significantly associated to the incidence of cervical cancer. The multivariate logistic regression analysis confirmed that not knowing that cervical cancer can be prevented (OR=6.85), the history of passive smoking (OR=4.04), parity more than two times (OR=2.89) and history of birth control pills consumption more than 10 years (OR=6.52) were the independent factors that were associated with the cervical cancer incidence.

Conclusions: Parity more than two times, history of birth control pills consumption more than 10 years, history of passive smoking, not knowing that cervical cancer can be prevented and never having a pap smear test were the factors associated with cervical cancer incidence.

Cancer, Cervical cancer, age of marriage, number of marriage, parity, birth control pills, smoking
  1. Kementrian Kesehatan Republik Indonesia. Situasi penyakit kanker. http://www.depkes.go.id/resources/download/pusdatin/infodatin/infodatin-kanker.pdf (accessed August 22, 2015).
  2. Rasjidi I. Deteksi dini, dan pencegahan kanker pada wanita. Jakarta: CV Sagung Seto; 2009.
  3. Chung SH, Franceschi S, dan Lambert PF. Estrogen and ERα: culprits in cervical cancer. Trends Endocrinol Metab. 2010;21(8):504-511.
  4. World Health Organization. Comprehensive cervical cancer prevention and control: a healthier future for girls and women. http://apps.who.int/iris/bitstream/10665/78128/3/9789241505147_eng.pdf?ua=1 (accessed January 14, 2017).
  5. Louie KS, Sanjose S de, Diaz M, Castellsague, Herrero R, Meijer CJ, Shah K, Franceshi S, Munoz N, Bosch FX. Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. Br J Cancer. 2009;100:1191-1197.
  6. Burk R, Ho G, Beardsley L, Lempa M, Peters M, Bierman R. Sexual behavior and partner characteristics are the predominant risk factors for genital human papillomavirus infection in young women. J Infect Dis. 1996;174(4):679-89.
  7. Boardman CH, Sonoda Y. Cervical Cancer Staging. http://emedicine.medscape.com/article/2006486-overview (accessed August 22, 2015).
  8. Liu ZC, Liu WD, Liu YH, Ye XH, Chen SD. Multiple Sexual Partners as an independent risk factor for cervical cancer: a meta-analysis of epidemiological studies. Asian Pac J Cancer Prev. 2015;16(9):3893-3900.
  9. Munoz N, Franceschi S, Bosetti C, Moreno V, Herrero R, Smith J, Shah K, Meijer C, Bosch X. Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. The Lancet. 2002;359(9312):1093-1101.
  10. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam S, Cain J, Garcia F, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis. 2012;16(3):175-204.
  11. Autier P, Coibion M, Huet F, Grivegnee AR. Transformation zone location and intraepithelial neoplasia of the cervix uteri. Br J Cancer. 1996;74(3):488-490.
  12. BKKBN. Pil KB. http://www.bkkbn-jatim.go.id/bkkbn-jatim/html/pil.htm (accessed August 22, 2015).
  13. Chan WK, Klock G, Bernard HU. Progesterone and glucocorticoid response elements occur in the long control regions of several human papillomaviruses involved in anogenital neoplasia. J Virol. 1989;63(8):3261–3269.
  14. Moreno V, Bosch FX, Munoz N, Meijer CJ, Shah KV, Walboomers JM, Herrero R, Franceschi S. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: The IARC multicentric case-control study. Lancet 2002;359(9312):1085-92.
  15. Syrjanen K, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J, Podistov J, et al. Oral contraceptives are not an independent risk factor for cervical intraepithelial neoplasia or high-risk human papillomavirus infections. Anticancer Res. 2006;26(6C):4729-40.
  16. Hellberg D, Nilsson S, Haley NJ, Hoffman D, Wynder E. Smoking and cervical intraepithelial neoplasia: nicotine and cotinine in serum and cervical mucus in smokers and nonsmokers. Am J Obstet Gynecol. 1988;158(4):910-3.
  17. Vaccarella S, Herrero R, Snijders P, Dai M, Thomas J, Hieu NT, Ferreccio C, et al. Smoking and human papillomavirus infection: Pooled analysis of the International Agency for Research on Cancer HPV Prevalence Surveys. Int J Epidemiol. 2008;37(3):536–546.
  18. Alberto J, Moutinho F. Smoking and cervical cancer. ISRN Obstet Gynecol. 2011;847684.
  19. International Agency for Research on Cancer. IARC handbook of cancer prevention http://www.iarc.fr/en/publications/pdfs-online/prev/handbook10/HANDBOOK10.pdf (accessed January 7, 2017).
  20. American Cancer Society. The American cancer society guidelines for the prevention and early detection of cervical cancer. https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html (accessed August 19, 2019).
  21. Romejko-Wolniewicz, E. Cervical cancer knowledge, prevention and exposure to risk factors among students from various countries. Medical University of Warsaw, Department of Obstetrics and Gynaecology Warsaw, Poland. IFCPC 2017 World Congress. http://www.asccp.org/Assets/d3474b4c-ccb9-4e7a-8db3-215ff70933d9/636281254732730000/x-world-congress-17-presentation-ewa-romejko-wolniewicz-1-pptx-pdf. (accessed September 9, 2019).
  22. Adeyemi O, Daramola E, Adaiah S, Francis E, Jubril K, Kehinde O, Rose A. Women's knowledge of cervical cancer and uptake of Pap smear testing and the factors influencing it in a Nigerian tertiary hospital. JCRP. 2018;5(3):105-111.

Full Text:
Article Info
Submitted: 2018-12-26
Published: 2019-12-27
Section: Research Articles
Article Statistics: 182 173