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Is use of hormone replacement therapy associated with increased detection of human papillomavirus and potential risk of HPV-related genital cancers?aDepartment of Epidemiology, bDepartment of Family Medicine, cDepartment of Biostatistics, dVeterans Affairs Medical Center, eDepartment of Pathology, University of Iowa, Iowa City, IA.AIM: Long-term duration in oral contraceptive (OC) use is a risk factor for female genital cancers and in vivo studies have shown progestins stimulate human papillomavirus (HPV) gene expression. A similar role for hormone replacement therapy (HRT) has received little evaluation. METHODS: Cervical/vaginal specimens were obtained to detect HPV from postmenopausal women (N=429) seeking annual gynecologic care at baseline and at 12-month follow-up. HPV was evaluated by PCR/DNA sequqencing. RESULTS: HPV prevalence was 14% and 6% had high-risk, oncogenic types. HPV prevalence was similar across current, past, and never HRT users. After adjustment for HPV-related risk factors, current and past user status showed no increased viral detection compared to never users. Duration also did not elevate risk among current HRT users. However, longer duration (adj. OR=1.8/yr, 95% CI: 1.1-3.1) and longer latency (adj.OR=4.8/yr, 0.8-30.9) among past users of estrogen/progestin regimens were associated with greater risk. Women with persistent infection compared to those who tested HPV negative at both HPV collection times were more likely to have a history of an HPV-related disease (OR=3.8, CI:1.3-11.0) or an abnormal Pap smear (OR=3.8, 1.2-12.0). CONCLUSIONS: These findings suggest that a significant percentage of older women have detectable HPV and persistent infection that puts them at increased risk of genital cancers and warts. There was an increased risk of HPV detection among HRT users particularly combination regimens in association with duration in use, suggesting that like oral contraceptives, HRT hormones may affect viral expression and subsequent risk of genital cancer. For more information, contact michele-hogue@uiowa.edu Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Viral Oncogenesis. |
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