Which of the following is an established co-factor that increases the risk of progression of high-grade CIN to invasive cervical carcinoma in women already infected with high-risk HPV?

• A Combined oral contraceptive use for less than 2 years
• B Breastfeeding exceeding 12 months
• C Body mass index greater than 30
• D Cigarette smoking ✓

Explanation

Smoking is a well-established co-factor for cervical carcinogenesis. Tobacco-specific nitrosamines are concentrated in cervical mucus, cause local immunosuppression and DNA adduct formation, and promote persistence of HPV infection and progression of CIN to invasive cancer. Long-term combined oral contraceptive use beyond 5 years shows only a weak, confounded association, while obesity and breastfeeding have no established causal link to malignant progression of CIN.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.