RISK-FACTORS FOR INVASIVE CERVICAL-CANCER IN KENYAN WOMEN

Background. Few epidemiological investigations of invasive cervical cancer have been conducted in Sub-Saharan African populations. Methods. Using information collected as part of the hospital-based World Health Organization (WHO) Collaborative Study of Neoplasia and Steroid Contraceptives, we examined potential risk factors for invasive cervical cancer among Kenyan women. In all 112 women with histologically confirmed invasive cervical cancer diagnosed at the Kenyatta National Hospital, Nairobi, Kenya, between June 1981 and September 1988 and 749 control subjects were included in the present analyses. All women were interviewed regarding their medical and reproductive history, methods of birth control, and history of sexual relationships and sexually transmitted infections. Multiple logistic regression procedures were used to derive maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). Results. After adjusting for age, several factors were found to be associated with invasive cervical cancer. These include multiple sexual partners, early age at first sexual intercourse (OR = 1.9 and 2.6 for women reporting first intercourse at age 16-17 years and < 15 years, respectively, compared to women with first intercourse greater than or equal to 18 years), history of abnormal vaginal discharge (OR = 13.8, 95% CI: 8.3-23.0), and history of gonorrhoeal infection (OR = 3.2, 95% CI: 1.6-6.2). Low educational attainment and multiparity were also associated with the risk of invasive cervical cancer. Although the Papanicolaou smear has been extensively used as a screening method for cervical cancer in many countries, only three cases and four controls reported ever having a Papanicolaou smear (2.6% cases and 0.5% of controls). Conclusions. As has been observed in other parts of the world, cervical neoplasia in Kenya appears to be a late consequence of venereally transmitted carcinogenic agents.