Purpose: Investigating the effects of active smoking, passive smoking and semen of tobacco smoking sexual partners on the carcinogenesis of uterine cervix.
Introduction: It is now well-established that persistence of Human Papillomavirus (HPV) infection is the strongest epidemiologic factor associated with intraepithelial neoplasia and cancer of cervix, as well as in other related locations such as in the vagina, vulva, anus, oral cavity, etc. A 1999 study indicates that the worldwide HPV prevalence in cervical carcinomas is 99,7 per cent. Multiple factors seem to intervene on cervical carcinogenesis, many of them related to tobacco, especially by direct local carcinogenic effect and local immunosuppression. Many studies have also shown that active or passive smoking in women (family-work environment, meeting places, etc.) greatly affects the occurrence, progression and degree of malignancy of carcinogenesis. Furthermore, particularly increased levels of nicotine and cotinine in the cervical mucus as well as prostate sperm fluids and urinary cotinine:creatinine ratios in smokers and passive smokers indicate that tobacco constituents do indeed reach the uterine cervix and lead to increased modification of DNA in cervical epithelium, suggesting biochemical evidence consistent with smoking as a cause of cervical cancer. The research presented today, though it took place over 30 decades ago (1975-1986 at the University Gynecological and Obstetric Clinic of Homburg ad Saar), we hope will serve as a reminder and contributing factor for further examination of the increased risk of cervical cancer in non-smoking women living with smoking partners.
Study: The study analyzed a total of one thousand five-hundred and forty (1,540) medical history sheets (krankenblätter) of women aged from eighteen to seventy-four (18-74) years old that were admitted, treated, examined (PAP TEST) or referred for further tests by their family physicians to the Homburg ad Saar Clinic between 1975-1986. The study evaluated the general medical history of the 1,540 women with a special focus on gynecological and obstetric related data and gathered additional information from patients through written questionnaires completed via phone, mail or personal interviews. Among a range of factors and data studied during the research, our current presentation and discussion will focus on the development of cervical neoplasms in women, examining results from three different study groups: smokers, passive-smokers and women with smoking sexual partners.
Results: Five hundred and forty-four cases (544) out of the overall study sample of one thousand five-hundred and forty (1,540) women, were identified as cases with pathological cell abnormalities (35.32%). Following diagnosis and treatment of transient lesions due to various inflammations (vaginitis, cervicitis etc.) one hundred and twelve (112) cases (20.59%) showed varying degrees of mild/reversible up to CIN 1-3 intraepithelial lesions. From the above sample of one hundred and twelve 112 cases, nineteen cases (19) were smoke free women who never smoked themselves, were not exposed to passive smoking and had non-smoker partners (16.96%). Forty-four (44) cases (39.29%) were female smokers, twenty-two (22) cases (19.64%) were women exposed to regular passive smoking (family-work environment) with a smoke-free partner and twenty-seven (27) cases (24.11%) were women non-smokers with a smoker partner. From the above findings, intraepithelial lesions were found to be higher (and with a progressive malign ratio) on the study groups that were associated with tobacco use either active or passive and therefore, the synergistic harmful effect of smoking, progressively from passive smokers to active smokers, is clearly evident on the occurrence and progression of cervical malignancies. As already mentioned above, the presence of HPV has been widely proven to be almost exclusively the cause of different degrees of neoplasia in the cervix for more than 99.7% of cervical carcinogenesis. However, the harmful effects of a) active smoking, b) passive smoking and c) the exposure to tobacco constituents through an active smoker partner, in women, should be sought and possibly attributed to the catalytic reduction of cervical self-defense and overall cervical immunity disruption which results to the exposure of cervix to elevated levels of nicotine-cotinine and cancer-causing chemicals related to smoking, may work together with certain types of HPV limiting the natural ability of the cervix to defend against carcinogenesis and therefore increase the likelihood of developing cancer.
Conclusion: Since the almost exclusively cause of cervical neoplasms is due to the presence and carcinogenic activity of HPV, the harmful/synergistic effect of smoking, passive smoking and partner smoking cannot be attributed to the direct carcinogenic effect of nicotine but to the overall damage of the immune system as we as the reduction of cervical self-defense making it more vulnerable to the carcinogenic nature of HPV, in particular the increased pathogenic types 16 and 18. Lastly, another potential correlation that could be further examined is the potential effects of tobacco constituents in cervical fluids on the self-defense system of the male reproductive system.