Time since first sexual intercourse and the risk of cervical cancer
Open accessAbstract
Young age at first sexual intercourse (AFI) is an important risk factor for cervical cancer, but no simple statistical model of its influence has been established. We investigated the relationship between risk of cervical carcinoma and time since first intercourse using data on monogamous women (5,074 cases and 16,137 controls) from the International Collaboration of Epidemiological Studies of Cervical Cancer. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from pooled data on 20 studies using conditional logistic regression. The OR for invasive cervical carcinoma is approximately proportional to the square of time since first intercourse (exponent 1.95, 95% CI: 1.76–2.15) up to age 45. First cervical infection with human papillomavirus (HPV) often occurs soon after first sexual intercourse, so early AFI is a reasonable proxy for early age at first exposure to HPV. In addition, age‐specific incidence rates of cervical cancer in unscreened populations remain fairly constant above age 45. Cervical cancer thus resembles other cancers caused by strong early‐stage carcinogens, with incidence rates proportional to a power of time since first exposure and also resembles cancers of the breast and other hormone‐dependent epithelia, where a similar flattening of age‐specific incidence rates is seen at the time menopausal changes start. Taken together, these observations suggest that HPV vaccination may prevent the majority of cervical cancers by delaying HPV infection without necessarily providing lifetime protection against HPV.
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Truncation at age 40 years was motivated by the reduced likelihood of infections acquired beyond this age progressing to cancer due to postmenopausal hormonal patterns and shorter time to develop cervical cancer in older age.
“truncation at this age was motivated by the reduced likelihood of infections acquired beyond this age to progress to cancer due to the hormonal patterns after menopause, and the shorter time to develop cervical cancer in this older age group.34, 35”
From Evidence-based impact projections of single-dose human papillomavirus vaccination in India: a modelling study (2022) · cites this paper as [35]
The Discussion links lower cancer risk from HPV infections acquired at older ages to menopausal changes. However, Materials and Methods specifies truncation at age 45, not 40, and the cited passages do not give a shorter time to develop cancer as a reason for truncation. Page numbers are unavailable in our copy. (LLM, conf=0.88)
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- Authors
- Plummer, M., Peto, J., Franceschi, S., & ; on behalf of the International Collaboration of Epidemiological Studies of Cervical Cancer
- Affiliations
- Centre international de recherche sur le cancer (FR)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Plummer, Martyn
- Venue
- International Journal of Cancer
- Publisher
- Wiley
- Published
- 2011-08-12
- Volume
- 130
- Issue
- 11
- Pages
- 2638-2644
- ISSN
- 0020-7136 (ISSN-L)
- 1097-0215
- PMC
- PMC3982220
- OpenAlex
- W1972678560
- Cited by
- 172
- References
- 32
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 12 · 2023: 7 · 2022: 16 · 2021: 15 · 2020: 21 · 2019: 9 · 2018: 12 · 2017: 7 · 2016: 10 · 2015: 14 · 2014: 14 · 2013: 11 · 2012: 7
- FWCI
- 7.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Cancer (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
- Funders
- World Health Organization
- University of Southern California
- Universitetet i Tromsø
- University of Otago
- London School of Hygiene and Tropical Medicine
- Università degli Studi di Milano
- Instituto Nacional de Cancerología
- Cancer Research UK
- Lunds Universitet
- Prince of Songkla University
- Ministère de la Santé
- Akademiska Sjukhuset
- Universidade de São Paulo
- Uppsala Universitet
- University of the Philippines
- National Health Laboratory Service
- National Institutes of Health
- Cancer Council NSW
- National Cancer Institute (ZIACP010206, ZIACP010210, ZIACP010124)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- cervical cancer, age at first sexual intercourse, human papillomavirus, HPV infection, HPV vaccination, age-specific incidence
- MeSH terms
- Adult, Age Factors, Aged, Uterine Cervical Neoplasms, Female, Humans, Menarche, Middle Aged, Risk, Sexual Behavior, Time Factors, Bias, Logistic Models, Odds Ratio, Papillomavirus Infections, Papillomavirus Vaccines
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