PARIS — Cancer and tobacco are a dangerous combination. This adage holds particularly true for cervical cancer, which is induced by high-risk human papillomavirus (HPV). Julia Maruani, MD, a gynecologist in Marseille, France, described this association during a press conference at the French Society of Colposcopy and Cervico-Vaginal Pathology Congress.
4500 Chemical Compounds
To clarify the role of tobacco in cervical cancer, Maruani observed that cigarettes contain nearly 4500 chemical compounds, 60 of which are carcinogenic. "For example, we know that benzopyrene increases viral load, while nitrosamines have a carcinogenic effect," she said. "And don't believe that nicotine has no impact. While not directly affecting carcinogenesis, it plays a harmful role in terms of immunosuppression. Tobacco alters all components of immunity: Cellular, humoral, local, and systemic."
Indeed, tobacco is the leading modifiable risk factor for cancers, contributing to 13% of all cases. When considering cervical cancer in women, tobacco and HPV are the main risk factors. The same applies to cancers of the pharynx and nasopharynx. "There is an extremely strong association between cancer and tobacco for all sites affected by HPV infection," said Maruani.
Supporting this notion, the American National Health and Nutrition Examination study, conducted between 2011 and 2016 with 3833 women, showed that tobacco exposure (passive smoking) increases the risk for HPV infection by 32%. Among female smokers, this risk is increased by 70%, after adjustments for numerous variables such as education and age.
Decreased Viral Clearance
How does tobacco act? It affects all stages of infection and immune response, including HPV replication, expression of oncoproteins E6 and E7 (which facilitate lesion development), DNA damage, and immune response. Tobacco not only increases the likelihood of contracting HPV more frequently and being a carrier more often due to poorer immunity but also decreases viral clearance, explained Maruani. A study on Chinese women showed that smokers had a 50% lower probability of clearing the virus. It has also been shown that this probability of HPV clearance is proportional to the duration, quantity, and frequency of tobacco consumption.
Finally, a study observed that tobacco was even more harmful in terms of lesions when smoking began before encountering HPV.
"In summary, smoking increases the risk for HPV infection by impairing immunity and reducing antibody titers. This diminishes clearance — and thus increases the persistence of HPV infection — and increases the risk of precancerous lesions and cancers. Considering that tobacco is even more harmful when started early, there is a real need for a more effective policy for tobacco cessation support and prevention among young people," said Maruani.
"Unfortunately, people are left alone with their addiction when they should be able to benefit from long and regular consultations because smoking is a very strong addiction," she concluded.
This story was translated from the Medscape French edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.