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Regional Distribution of Human Papillomavirus DNA and Other Risk Factors for Invasive Cervical Cancer in Panama¹

Molecular Virology and Immunology Program, Department of Pathology, McMaster University, Hamilton, Ontario, Canada [J. A., C. L., W. E. R.]; Environmental Epidemiology Branch, National Cancer Institute, NIH, Bethesda, Maryland [A. H., L. B.]; and Division of Epidemiology, Gorgas Memorial Laboratory [W. C. R., M. B., M. E. d. l. G.] and Instituto Oncologico Nacional [J. G.], Panama City, Republic of Panama

A population-based national cancer registry has documented strikingly different regional incidence rates of cervical cancer in the Republic of Panama. Such regional differences in disease rates could represent regional differences in the occurrence of risk factors, in particular, human genital papillomaviruses (HPV). This study enrolled newly diagnosed invasive cancer patients in the Republic of Panama over an 18-mo period. Behavioral risk factors were measured by interviewing cases and matched controls. In addition, DNA extracted from biopsies of the cancers was tested for HPV sequences. Early age at first coitus, multiple pregnancies, and nonparticipation in Pap smear screening programs were significant risk factors for cervical cancer in this population. These factors and low levels of education occurred more frequently among women residing in regions with higher cancer rates than women residing in the region with lower cancer rates. HPV DNA was detected most frequently (70%) among cases from the region with the lowest cancer rate (30 of 100,000) and least frequent (54%) among cases where the cancer rate was the highest (51 of 100,000). The observations suggest that risk factors other than HPV contribute to the differences in cervical cancer rates among women residing in various regions of Panama.

¹ This study was supported by Contract NC1-CP-EB-41026 and Grant R01-CA-42042 from the National Cancer Institute, NIH, and by a grant from the National Cancer Institute of Canada. The protocol used in this study was reviewed by the Gorgas Memorial Laboratory Human Subjects Committee and the Office of Protection of Research Subjects, NIH. All participants were volunteers who gave informed consent.

² Present address: Viral Exanthems and Herpesvirus Branch, Center for Infectious Diseases, Center for Disease Control, Atlanta, GA. 30333.

³ To whom requests for reprints should be addressed, at Department of Pathology, McMaster University, Hamilton, Ontario, Canada L8N 3Z5.

Received 3/30/89. Revised 7/17/89. Accepted 7/21/89.