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Servikal İntraepithelial Lezyonlarda Demografik Özellikler, Folat, Vitamin B12 ve Vitamin D Serum Seviyeleri

Year 2020, Volume: 6 Issue: 3, 499 - 505, 01.01.2020

Abstract

Amaç: Serviks kanseri gelişiminde Human papilloma virüs HPV en önemli faktör olmakla beraber bu süreçte kofaktörler de rol oynamaktadır. Çalışmamızda, servikal intraepithelial lezyonlarda demografik özellikleri, folat, B12 vitamini, D vitamini serum seviyelerini araştırdık.Gereç ve Yöntemler: Çalışmaya kolposkopi yapılan ve folat, B12 vitamini ve D vitamini serum düzeyleri ölçülmüş hastalar dahil edildi. Histoloji sonuçlarına göre hastalar, servikal intraepitelyal neoplazi derece 1 veya normal ≤ CIN 1 ve servikal intraepitelyal neoplazi derece 2 veya daha yüksek anormallikler ≥ CIN 2 olan iki gruba ayrıldı. Bu iki grup arasında, hastaların yaşı, paritesi, abortus sayısı, menopozal durumu, sigara kullanımı, rahim içi araç kullanımı, postkoital kanama şikayeti gibi demografik özelliklerinin yanı sıra, folat, B12 vitamini ve D vitamini serum seviyeleri karşılaştırıldı.Bulgular: 83 hasta çalışma kapsamında değerlendirildi. Hastaların ortanca yaşı 41 idi ve 22ʼsi %26,5 hâlen sigara içiyordu. Hastaların hiçbiri herhangi bir vitamin veya folik asit takviyesi almıyordu. Histoloji sonuçlarının en yüksek derecesine göre; 67 %80,7 hastada ≤ CIN 1 ve 16 %19,3 hastada ≥ CIN 2 lezyonu tespit edildi. Serum folat, B12 vitamini ve D vitamini düzeyleri gruplar arasında farklılık göstermedi. Mevcut sigara kullanımı ≥ CIN 2 lezyonlarının ortaya çıkmasına bağlı olan tek parametre idi %36,4'e karşılık %13,1; p=0,018 . Ayrıca, ≥ CIN 2 lezyonlarının ortaya çıkmasının sigara içme süresi ile arttığı belirlendi p=0,031 . Sonuç: Folat, B12 ve D vitaminleri, vücutta ortalama veya subnormal seviyelerde bulunduğunda ≥ CIN 2 lezyonları için risk faktörü değildir. Sigara kullanımı, serviks kanseri gelişiminde önemli bir kofaktördür. Risk, sigara kullanım süresi ile artmaktadır. Hastalara sigara kullanımının sonlandırılması önerilmelidir

References

  • Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global Cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68:394‐424.
  • Moscicki AB, Schiffman M, Kjaer S, Villa LL. Chapter 5: Updating the natural history of HPV and anogenital cancer. Vaccine 2006; 24(3):42-51.
  • Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, Snijders PJ, Peto J, Meijer CJ, Muñoz N. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999; 189(1):12-9.
  • Maglennon GA, McIntosh PB, Doorbar J. Immunosuppression facilitates the reactivation of latent papillomavirus infections. J Virol 2014; 88(1):710-6.
  • Myung SK, Ju W, Kim SC, Kim H. Vitamin or antioxidant intake (or serum level) and risk of cervical neoplasm: A meta-analysis. BJOG 2011; 118(11):1285-91.
  • Piyathilake CJ, Badiga S, Paul P, Vijayaraghavan K, Vedantham H, Sudula M, Sowjanya P, Ramakrishna G, Shah KV, Partridge EE, Gravitt PE. Indian women with higher serum concentrations of folate and vitamin B12 are significantly less likely to be infected with carcinogenic or high-risk (HR) types of human papillomaviruses (HPVs). Int J Women Health 2010; 2:7-12.
  • Piyathilake CJ, Henao OL, Macaluso M, Cornwell PE, Meleth S, Heimburger DC, Partridge EE. Folate is associated with the natural history of high risk human papillomaviruses. Cancer Res 2004; 64(23):8788-93.
  • Abike F, Engin AB, Dunder I, Tapisiz OL, Aslan C, Kutluay L. Human papillomavirus persistence and neopterin, folate and homocysteine levels in cervical dysplasias. Arch Gynecol Obstet 2011; 284(1):209-14.
  • Piyathilake CJ, Macaluso M, Alvarez RD, Bell WC, Heimburger DC, Partridge EE. Lower risk of cervical intraepithelial neoplasia in women with high plasma folate and sufficient vitamin B12 in the post‐folic acid fortification era. Cancer Prev Res 2009; 2(7):658-64.
  • Vahedpoor Z, Jamilian M, Bahmani F, Aghadavod E, Karamali M, Kashanian M, Asemi Z. Effects of long-term vitamin D supplementation on regression and metabolic status of cervical intraepithelial neoplasia: A randomized, double-blind, placebo-controlled trial. Horm. Cancer 2017; 8(1):8-67.
  • Ozgu E, Yilmaz N, Baser E, Gungor T, Erkaya S, Yakut HI. Could 25-oh vitamin D deficiency be a reason for HPV infection persistence in cervical premalignant lesions? J Exp Ther Oncol 2016; 11(3):177-80.
  • Sedjo RL, Fowler B, Schneider A, Henning S, Hatch K, Giuliano A. Folate, vitamin B12, and homocysteine status. Findings of no relation between human papillomavirus persistence and cervical dysplasia. Nutrition 2003; 19(6):497-502.
  • Alberg AJ, Selhub J, Shah KV, Viscidi RP, Comstock GW, Helzlsouer KJ. The risk of cervical cancer in relation to serum concentrations of folate, vitamin B12, and homocysteine. Cancer Epidemiol Biomarkers Prev 2000; 9(7):761-4.
  • Hosono S, Matsuo K, Kajiyama H, Hirose K, Suzuki T, Kawase T, Kidokoro K, Nakanishi T, Hamajima N, Kikkawa F, Tajima K, Tanaka H. Association between dietary calcium and vitamin D intake and cervical carcinogenesis among Japanese women. Eur J Clin Nutr 2010; 64(4):400-9.
  • Momenimovahed Z, Salehiniya H. Incidence, mortality and risk factors of cervical cancer in the world. Biomedical Research & Therapy 2017; 4(12):1795-811.
  • Fenech M. Nutrition and genome health. Forum Nutr 2007; 60:49-65.
  • Wilke CM, Hall BK, Hoge A, Paradee W, Smith DI, Glover TW. FRA3B extends over a broad region and contains a spontaneous HPV 16 integration site: Direct evidence for the coincidence of viral integration sites and fragile sites. Hum Mol Genet 1996; 5(2):187-95.
  • International Collaboration of Epidemiological Studies of Cervical Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer 2007; 120(4):885‐91.
  • Vaccarella S, Herrero R, Snijders PJ, Dai M, Thomas JO, Hieu NT, Ferreccio C, Matos E, Posso H, de Sanjosé S, Shin HR, Sukvirach S, Lazcano-Ponce E, Muñoz N, Meijer CJ, Franceschi S. IARC HPV Prevalence Surveys (IHPS) Study Group. Smoking and human papillomavirus infection: Pooled analysis of the International Agency for Research on Cancer HPV Prevalence Surveys. Int J Epidemiol 2008; 37:536-46.
  • Syrjanen K, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J, Podistov J, Chemeris G, Sozaeva L, Lipova E, Tsidaeva I, Ivanchenko O, Pshepurko A, Zakharenko S, Nerovjna R, Kljukina L, Erokhina O, Branovskaja M, Nikitina M, Grunberga V, Grunberg A, Juschenko A, Santopietro R, Cintorino M, Tosi P, Syrjänen S. Smoking is an independent risk factor for oncogenic human papillomavirus (HPV) infections but not for high-grade CIN. Eur J Epidemiol 2007; 22:723- 35.
  • Harris TG, Kulasingam SH, Kiviat NB, Mao C, Agoff SN, Feng Q, Koutsky LA. Cigarette smoking, oncogenic human papillomavirus, Ki-67 antigen, and cervical intraepithellal neoplasia. Am J Epidemiol 2004; 159(9):834-42.
  • Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, Winer R, Clifford GM. Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: A meta-analysis update. Int J Cancer 2007; 121(3):621- 32.

Demographic Characteristics and the Folate, Vitamin B12 and Vitamin D Serum Levels in Cervical Intraepithelial Lesions

Year 2020, Volume: 6 Issue: 3, 499 - 505, 01.01.2020

Abstract

Objective: Human papillomavirus HPV infection is necessary but not sufficient for the development of cervical cancer, and some other factors are known to play a role in this progression. Here, we aimed to investigate the serum levels of folate, vitamin B12, and vitamin D, and the demographic characteristics in cervical cancer precursor lesions.Material and Methods: Patients who had undergone colposcopy and tested for the serum levels of folate, vitamin B12, and vitamin D were included in this study. Based on histological outcomes, patients were grouped as those with cervical intraepithelial neoplasia grade 1 or lesser abnormalities ≤ CIN 1 and those with cervical intraepithelial neoplasia grade 2 or higher abnormalities ≥ CIN 2 . Among these two groups, patients were compared in terms of demographic characteristics such as age; parity; abortus number; menopausal status; smoker status; use of intrauterine devices; postcoital bleeding complaint and the serum levels of folate, vitamin B12, and vitamin D.Results: 83 patients were enrolled in the present study. The median age of the study population was 41 years and 22 patients 26.5% were currently smokers. None of the patients were using any vitamin or folate supplements. According to the highest grade of histology outcomes; 67 80.7% patients had ≤ CIN 1 and 16 19.3% patients had ≥ CIN 2 lesions. The serum levels of folate, vitamin B12, and vitamin D did not differ between the groups. Current smoking was the only parameter related with the occurrence of ≥ CIN 2 lesions 36.4% vs. 13.1%; p=0.018 . In addition, the occurrence of ≥ CIN 2 lesions increased with the duration of smoking p=0.031 .Conclusion: Folate, and vitamins B12 and D are not risk factors for ≥ CIN 2 lesions when present at average or subnormal levels. Current smoking is a cofactor for the occurrence of ≥ CIN 2 lesions. Thus, the risk increases with the duration of smoking. Smoking cessation should be suggested in women with cervical premalignant lesions

References

  • Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global Cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68:394‐424.
  • Moscicki AB, Schiffman M, Kjaer S, Villa LL. Chapter 5: Updating the natural history of HPV and anogenital cancer. Vaccine 2006; 24(3):42-51.
  • Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, Snijders PJ, Peto J, Meijer CJ, Muñoz N. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999; 189(1):12-9.
  • Maglennon GA, McIntosh PB, Doorbar J. Immunosuppression facilitates the reactivation of latent papillomavirus infections. J Virol 2014; 88(1):710-6.
  • Myung SK, Ju W, Kim SC, Kim H. Vitamin or antioxidant intake (or serum level) and risk of cervical neoplasm: A meta-analysis. BJOG 2011; 118(11):1285-91.
  • Piyathilake CJ, Badiga S, Paul P, Vijayaraghavan K, Vedantham H, Sudula M, Sowjanya P, Ramakrishna G, Shah KV, Partridge EE, Gravitt PE. Indian women with higher serum concentrations of folate and vitamin B12 are significantly less likely to be infected with carcinogenic or high-risk (HR) types of human papillomaviruses (HPVs). Int J Women Health 2010; 2:7-12.
  • Piyathilake CJ, Henao OL, Macaluso M, Cornwell PE, Meleth S, Heimburger DC, Partridge EE. Folate is associated with the natural history of high risk human papillomaviruses. Cancer Res 2004; 64(23):8788-93.
  • Abike F, Engin AB, Dunder I, Tapisiz OL, Aslan C, Kutluay L. Human papillomavirus persistence and neopterin, folate and homocysteine levels in cervical dysplasias. Arch Gynecol Obstet 2011; 284(1):209-14.
  • Piyathilake CJ, Macaluso M, Alvarez RD, Bell WC, Heimburger DC, Partridge EE. Lower risk of cervical intraepithelial neoplasia in women with high plasma folate and sufficient vitamin B12 in the post‐folic acid fortification era. Cancer Prev Res 2009; 2(7):658-64.
  • Vahedpoor Z, Jamilian M, Bahmani F, Aghadavod E, Karamali M, Kashanian M, Asemi Z. Effects of long-term vitamin D supplementation on regression and metabolic status of cervical intraepithelial neoplasia: A randomized, double-blind, placebo-controlled trial. Horm. Cancer 2017; 8(1):8-67.
  • Ozgu E, Yilmaz N, Baser E, Gungor T, Erkaya S, Yakut HI. Could 25-oh vitamin D deficiency be a reason for HPV infection persistence in cervical premalignant lesions? J Exp Ther Oncol 2016; 11(3):177-80.
  • Sedjo RL, Fowler B, Schneider A, Henning S, Hatch K, Giuliano A. Folate, vitamin B12, and homocysteine status. Findings of no relation between human papillomavirus persistence and cervical dysplasia. Nutrition 2003; 19(6):497-502.
  • Alberg AJ, Selhub J, Shah KV, Viscidi RP, Comstock GW, Helzlsouer KJ. The risk of cervical cancer in relation to serum concentrations of folate, vitamin B12, and homocysteine. Cancer Epidemiol Biomarkers Prev 2000; 9(7):761-4.
  • Hosono S, Matsuo K, Kajiyama H, Hirose K, Suzuki T, Kawase T, Kidokoro K, Nakanishi T, Hamajima N, Kikkawa F, Tajima K, Tanaka H. Association between dietary calcium and vitamin D intake and cervical carcinogenesis among Japanese women. Eur J Clin Nutr 2010; 64(4):400-9.
  • Momenimovahed Z, Salehiniya H. Incidence, mortality and risk factors of cervical cancer in the world. Biomedical Research & Therapy 2017; 4(12):1795-811.
  • Fenech M. Nutrition and genome health. Forum Nutr 2007; 60:49-65.
  • Wilke CM, Hall BK, Hoge A, Paradee W, Smith DI, Glover TW. FRA3B extends over a broad region and contains a spontaneous HPV 16 integration site: Direct evidence for the coincidence of viral integration sites and fragile sites. Hum Mol Genet 1996; 5(2):187-95.
  • International Collaboration of Epidemiological Studies of Cervical Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer 2007; 120(4):885‐91.
  • Vaccarella S, Herrero R, Snijders PJ, Dai M, Thomas JO, Hieu NT, Ferreccio C, Matos E, Posso H, de Sanjosé S, Shin HR, Sukvirach S, Lazcano-Ponce E, Muñoz N, Meijer CJ, Franceschi S. IARC HPV Prevalence Surveys (IHPS) Study Group. Smoking and human papillomavirus infection: Pooled analysis of the International Agency for Research on Cancer HPV Prevalence Surveys. Int J Epidemiol 2008; 37:536-46.
  • Syrjanen K, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J, Podistov J, Chemeris G, Sozaeva L, Lipova E, Tsidaeva I, Ivanchenko O, Pshepurko A, Zakharenko S, Nerovjna R, Kljukina L, Erokhina O, Branovskaja M, Nikitina M, Grunberga V, Grunberg A, Juschenko A, Santopietro R, Cintorino M, Tosi P, Syrjänen S. Smoking is an independent risk factor for oncogenic human papillomavirus (HPV) infections but not for high-grade CIN. Eur J Epidemiol 2007; 22:723- 35.
  • Harris TG, Kulasingam SH, Kiviat NB, Mao C, Agoff SN, Feng Q, Koutsky LA. Cigarette smoking, oncogenic human papillomavirus, Ki-67 antigen, and cervical intraepithellal neoplasia. Am J Epidemiol 2004; 159(9):834-42.
  • Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, Winer R, Clifford GM. Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: A meta-analysis update. Int J Cancer 2007; 121(3):621- 32.
There are 22 citations in total.

Details

Primary Language English
Journal Section Research Article
Authors

Hasan Aykut Tuncer This is me

Tayup Sımsek This is me

Publication Date January 1, 2020
Published in Issue Year 2020 Volume: 6 Issue: 3

Cite

Vancouver Tuncer HA, Sımsek T. Demographic Characteristics and the Folate, Vitamin B12 and Vitamin D Serum Levels in Cervical Intraepithelial Lesions. Akd Med J. 2020;6(3):499-505.