Cancer
Pregnancy and cervical cancer: a retrospective study of the associations of age at first pregnancy and parity with non-invasive and invasive cervical lesions among HIV-negative women in Senegal Mariama Bah* Mariama Bah Steve Hawes Rachel L. Winer Selly Ba Qinghua Feng Geoffrey S. Gottlieb Papa Salif Sow Marie Pierre Sy Nancy Kiviat John Lin
Cervical cancer is the leading cause of cancer-related deaths among Senegalese women. There is limited knowledge about the roles of age at first pregnancy (AFP) and parity in developing cervical intra-epithelial neoplasia (CIN) and invasive cervical cancer (ICC) in this population. We investigated the associations of AFP and parity with any CIN and ICC using data from four studies on cervical HPV/dysplasia/cancer conducted in Senegal between 1998 and 2011. Eligibility included being HIV-negative, 18 years or older, not currently pregnant, and having either cervical histology or cytology results. Missing data were imputed with Multiple Imputation by Chained Equations in R. AFP was grouped as 12-14, 15-16, 17-20, 21-24, and 25+, and parity as 0, 1-2, 3-4, 5-6, and 7+, with 21-24 and 1-2 as references, respectively. We conducted multinomial logistic regression in the general and HPV-positive (any type) populations. We adjusted for age, age at sexual initiation, marital status/type, lifetime number of male sex partners, birth control, smoking, and study. Among the 5,588 women in this study, the median AFP was 18 years (range: 12-42) and the median number of live births was 5 (range: 0-16). Younger AFP was associated with higher risks of CIN and ICC compared to older groups in both populations. In the general population, the associations of AFP and CIN were significant for the 12-14 (Odds Ratio (OR)=2.01, 95% CI:1.06-3.83) and 15-16 (OR=1.72, 95% CI:1.02-2.88) AFP groups. Parity was positively associated with CIN and ICC in both populations. Having 3-4 live births was significantly associated with ICC (OR=1.73, 95% CI:1.10-2.71) in the general population, and with CIN (OR=2.20, 95% CI:1.20-4.02) and ICC (OR=2.26, 95% CI:1.12-4.60) in the HPV-positive population. Early AFP had higher risks of CIN and higher parity had higher risks of CIN and ICC among HIV-negative women in Senegal. These findings can help inform future cancer prevention and screening strategies.