Endogenous sex steroids and risk of cervical carcinoma: results from the EPIC study
A partir des données de la cohorte européenne EPIC, cette étude évalue l'association entre le niveau d'hormones sexuelles stéroïdiennes et le risque de carcinome invasif du col de l'utérus
Background: Epidemiological data and animal models suggest that, despite the predominant role of human papillomavirus infection, sex steroid hormones are also involved in the etiology of invasive cervical carcinoma (ICC). Methods:99 ICC cases, 121 cervical intraepithelial neoplasia grade 3 (CIN3) cases and 2 control women matched with each case for center, age, menopausal status and blood collection-related variables, were identified in the EPIC study. Circulating levels of testosterone (T) and estradiol (E2); dehydroepiandrosterone sulfate (DHEAS); progesterone (pre-menopausal women); and sex hormone binding globulin (SHBG) were measured using immunoassays. Levels of free (f) T and E2 were calculated from absolute concentrations of T, E2 and SHBG. Odds ratios (OR) and 95% confidence intervals (CI) were computed using regularized conditional logistic regression. Results:Among pre-menopausal women, associations with ICC were observed for fT (OR for highest vs lowest tertile=5.16, 95% CI: 1.50-20.1). SHBG level was associated with a significant downward trend in ICC risk. T, E2, fE2 and DHEAS showed non significant positive association with ICC. Progesterone was uninfluential. Among post-menopausal women, associations with ICC were found for T (OR=3.14; 95% CI: 1.21-9.37), whereas E2, and fT showed non significant positive association. SHBG level was unrelated to ICC risk in post-menopausal women. No associations between any hormone and CIN3 were detected in either pre- or post-menopausal women. Conclusions:Our findings suggest for the first time that T and possibly E2 may be involved in the etiology of ICC. Impact:The responsiveness of cervical tumors to hormone modulators is worth exploring.