Risk Factors Of Cervical Cancer And Pre-cancers Detected Among Uyghur Minority Women From Poor Areas In Kashgar,Xinjiang

Objective: Through a screening and epidemiologic investigation program for cervical cancer among rural low-income Uyghur women,this study aimed at discussing risk factors for cervical cancer and precancerous lesions,especially the relationship between cervical cancer/precancerous lesions and risk factors such as obesity(including waist circumference,waist-hip ratio and waist-height ratio)and cooking smoke among these women.In addition,because of the high prevalence of obesity previously observed among these low-income Uyghur women,this study also investigated new indicators and suitable techniques for primary screening of obesity in low-income rural communities.Methods:(1)We performed cervical cancer screening program in two low-income Muslim Uyghur townships in Kashi(Kashgar)Prefecture,Xinjiang,China.More than 5,000 married women participated the screening,the epidemiological survey were including informed consent,quality control,questionnaires,physical examination,gynecological examination,histopathological examination and universal knowledge on cervical cancer prevention and treatment,we established the database of information for screening people,contact with those who had incomplete information via phone or letter.(2)We established a database for blood samples,and database for cervical lesions tissue of more than 100 copies of the Uyghur women(including the biopsy tissue of cervical cancer and precancerous lesions patients).(3)Using Epi Data software to import,censor,check and regulate the database.This database was analyzed by SPSS17.0 software,the analysis methods were Logistic single factor and multi-factor analysis,nonparametric test,analysis of variance,Pearson correlation analysis and ROC curve.Results:(1)Since the second epidemiology survey of the screening items is more complete,we took its data into the analysis.2824 married women aged 20-64 years old were attended the screening,of them about 88% lived on/below US$1.00/day,and 2,577 of these women were eligible for analyses as they have all information available and have no other reported chronic diseases.Among these women,there were 4 disease categories defined: 51 CIN1 cases,21 CIN2 cases,12 CIN3 cases,and 7 cases of cervical cancer,while the normal cases were 2486.As CIN2 and CIN3 are medium and high level precancerous lesions of the cervix,besides,to improve the statistical power,we combined cases of CIN2,CIN3 and cervical cancer for analyses against non-diseased women.(2)According to the Logistic single factor and multi-factor analysis,the following factors were found to be the risk factors for cervical cancer and precancerous lesions: big cooking smoke(sometimes choking,P=0.003,OR=4.942),cooking time>2 hours(P=0.004,OR=50.941),waist circumference ≥ 85cm(P=0.026,OR=2.360),the presence of warts(P=0.015,OR=27.755),smoking(P <0.001,OR = 38.539),married(P=0.009,OR=4.438),abnormal menstrual cycle(<21 or >35 days,P <0.001,OR=10.191),the number of sexual partners≥2(P=0.015,OR=2.358),taking contraceptives(P=0.025,OR=2.459),per capita annual income≤3000￥(P=0.020,OR=2.336)and age having first child<21 years old(P=0.040,OR=5.780).(3)The obesity situation of the screening population was: the BMI of the screening population was(24.8 ± 3.7)kg/m2,the rates of overweight and obesity were 1.9% and 18.5%,respectively,which were both higher than those of Han women(22.8% and 7.1%,P<0.05).There was a positive correlation among BMI,hip circumference,waist circumference,waist height ratio,waist-to-hip ratio and age,and the highest correlation was between hip circumference and BMI(correlation coefficient r=0.82).In the prediction of obesity,the values of AUC and YI of hip circumference were as high as 0.953 and 0.813,respectively,which were both remarkably higher than other tested indicators.Be used for predicting obesity,the cut-off value for hip circumference was HP>101.5cm.Conclusions:(1)The risk factors for cervical cancer and precancerous lesions are: heavy cooking smoke(sometimes choking),longer cooking time per meal,abdominal obesity,condyloma acuminatum,smoking,marriage,abnormal menstrual cycles,many sexual partners,taking contraceptive,annual per capita income and birth of first child at younger age.For the first time,this study has described heavy cooking smoke,large waist circumference and the presence of warts to be associated with cervical cancer and precancerous lesions in these Uyghur women residing in low-income rural communities in southern Xinjiang,China.These findings may provide useful guidance information for local preventive public health decisions.(2)The rate of obesity among the screened women is surprisingly high,and hip circumference,waist/height ratio and waist circumference have primary screening values in predicting obesity,among which hip circumference serves as the best indicator in screening obesity and overweight(the largest values for AUC and YI).