Male sexual behavior, penile HPV-DNA and cervical cancer : A pooled analysis of 7 case- control studies in Brazil, Colombia, Thailand, the Philippines, and Spain

Male sexual behavior, penile HPV-DNA and cervical cancer : A pooled analysis of 7 case- control studies in Brazil, Colombia, Thailand, the Philippines, and Spain

Xavier Castellsagu, Servei dÕ Epidemiologia I Registre del Cncer, Institut Catal dÕ Oncologia, Barcelona, Spain
F. Xavier Bosch, Servei dÕ Epidemiologia I Registre del Cncer, Institut Catal dÕ Oncologia, Barcelona, Spain
Nubia Muoz, International Agency for Research on Cancer, Lyon, France
Joseph Eluf-Neto, Depto. Medicina Preventiva, Faculdade Medicina, University Sao Paulo, Sao Paulo, Brazil
Saibua Chichareon, Assoc. Prof., D. of Obstetrics and Gynecology, F. of Medicine, PSU.
Cora Ngelangel, Clinical Epidemiology Unit, Philippine General Hospital. Manila, The Philippines
Mireia Dia, D. of Pathology, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands
Jan M.M. Walboomers, D. of Pathology, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands
Chris J.L.M. Meijer, D. of Pathology, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands
Corresponding e-mail : csaibua@ratree.psu.ac.th

Grant : International Agency for Research on Cancer
Presented : The 18th International Papillomavirus Conference, 23rd - 28th July 2000, Barcelona, Spain
Key words : male sexual behavior, penile HPV-DNA, cervical cancer

Objective : To estimate penile HPV-DNA prevalences in husbands of women with and with-out cervical cancer and identify independent male risk factors for cervical cancer (CC) in high-, intermediate-, and low-risk populations.

Methods : Combined data were analyzed from 1,925 husbands or current stable partners of women enrolled in 7 case-control studies of CIN III and invasive CC carried out by the IARC between 1985 in Brazil, Colombia, The Philippines, Spain and Thailand. Exfoliated cells were obtained by scraping the glans and distal urethra for HPV-DNA detection by PCR. Odds ratios (Ors) and 95% confidence intervals (CI) were estimated by logistic regression modeling. Brazil and Colombia were considered high-risk countries (age-adjusted incidence rates [AAIR] : 37.7 and 34.4), Thailand and The Philippines intermediate-risk countries (AAIR : 22.4 and 21.6) and Spain a low-risk country (AAIR : 7.1).

Preliminary Results : A total of 1,345 (70%) men provided adequate specimens for PCR testing. Penile HPV prevalences among control husbands were high in high-risk countries (19 to 30%), low to intermediate in intermediate-risk countries (5 to 9%), and low (4%) in Spain. Although penile HPV prevalences were in general higher in case husbands than in control husbands, no asso-ciations with CC risk were detected in any of the high-and intermediate-risk countries. In contrast, a strong association with penile HPV was found in Spain (OR = 7.6, 95% CI : 3.0-19.3). Male to female HPV prevalence ratios were above one in Brazil and colombia (1.8 and 1.4) and below 1 (0.6 to 0.8) in the lower-risk countries. Prevalence of ever contacts with prostitutes correlated also with CC incidence rates : 70 to 79% in Brazil and Colombia, and 40 to 57% in the lower-risk countries. Furthermore, ever contact with prostitutes, number of partners being prostitutes and young age at first sexual intercourse or age at marriage were all consistently and significantly associated with CC risk in intermediate and low-risk countries but not in the high-risk countries.

Conclusions : Population patterns of male contacts with prostitutes and male HPV preva- lences correlate well with CC incidence rates. In low-risk countries, both penile HPV and high-risk sexual behavior are the 2 most important male risk factors for CC. In high-risk countries, the fact that male HPV infection or surrogates are not associated with CC suggests that widespread high- risk male sexual behavior hampers the identification of an elevated risk linked to any of these risk factors when a case-control study design is used. We propose that in addition to the existence of well-implemented screening programs, male sexual behavior, especially widespread sexual contacts with prostitutes, is one of the key determinants of CC incidence patterns in the world.

BACK