Imperial College London
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DrVerenaZuber

Faculty of Medicine, School of Public Health

Senior Lecturer in Biostatistics
 
 
 
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v.zuber

 
 
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Location

 

526Medical SchoolSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Bowden:2023:10.1186/s12916-023-02965-w,
author = {Bowden, SJ and Doulgeraki, T and Bouras, E and Markozannes, G and Athanasiou, A and Grout-Smith, H and Kechagias, KS and Ellis, LB and Zuber, V and Chadeau-Hyam, M and Flanagan, JM and Tsilidis, KK and Kalliala, I and Kyrgiou, M},
doi = {10.1186/s12916-023-02965-w},
journal = {BMC Medicine},
pages = {1--15},
title = {Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies},
url = {http://dx.doi.org/10.1186/s12916-023-02965-w},
volume = {21},
year = {2023}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: Persistent infection by oncogenic human papillomavirus (HPV) is necessary although not sufficient for development of cervical cancer. Behavioural, environmental, or comorbid exposures may promote or protect against malignant transformation. Randomised evidence is limited and the validity of observational studies describing these associations remains unclear.Methods: In this umbrella review we searched electronic databases to identify meta-analyses of observational studies that evaluated risk or protective factors and the incidence of HPV infection, cervical intra-epithelial neoplasia (CIN), cervical cancer incidence and mortality. Following re-analysis, evidence was classified and graded based on a pre-defined set of statistical criteria. Quality was assessed with AMSTAR-2. For all associations graded as weak evidence or above, with available genetic instruments, we also performed Mendelian randomisation to examine the potential causal effect of modifiable exposures with risk of cervical cancer. The protocol for this study was registered on PROSPERO (CRD42020189995).Results: We included 171 meta-analyses of different exposure contrasts from 50 studies. Systemic immunosuppression including HIV infection (RR=2.20(95%CI=1.89-2.54)) and immunosuppressive medications for inflammatory bowel disease (RR=1.33(95%CI=1.27-1.39)), as well as an altered vaginal microbiome (RR=1.59(95%CI=1.40-1.81)) were supported by strong and highly suggestive evidence for an association with HPV persistence, CIN or cervical cancer. Smoking, number of sexual partners and young age at first pregnancy were supported by highly suggestive evidence and confirmed by Mendelian randomisation.Conclusions: Our main analysis supported the association of systemic (HIV infection, immunosuppressive medications) and local immunosuppression (altered vaginal microbiota) with increased risk for worse HPV and cervical disease outcomes. Mendelian randomisation confirmed the link for genetically predic
AU  - Bowden,SJ
AU  - Doulgeraki,T
AU  - Bouras,E
AU  - Markozannes,G
AU  - Athanasiou,A
AU  - Grout-Smith,H
AU  - Kechagias,KS
AU  - Ellis,LB
AU  - Zuber,V
AU  - Chadeau-Hyam,M
AU  - Flanagan,JM
AU  - Tsilidis,KK
AU  - Kalliala,I
AU  - Kyrgiou,M
DO  - 10.1186/s12916-023-02965-w
EP  - 15
PY  - 2023///
SN  - 1741-7015
SP  - 1
TI  - Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies
T2  - BMC Medicine
UR  - http://dx.doi.org/10.1186/s12916-023-02965-w
UR  - https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-02965-w
UR  - http://hdl.handle.net/10044/1/105303
VL  - 21
ER  -
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