Among women who are already infected with high-risk HPV, cigarette smoking increases the risk of progression to cervical carcinoma primarily through which mechanism?

• A Systemic elevation of oestrogen leading to increased HPV replication
• B Direct induction of HPV DNA integration into the host genome
• C Local immunosuppression within cervical tissues favouring viral persistence ✓
• D Somatic mutation of the TP53 gene in cervical epithelial cells

Explanation

Robbins describes smoking as a cofactor that roughly doubles the risk of cervical cancer in HPV-infected women. Carcinogenic nicotine derivatives concentrate in cervical mucus and produce a localised immunosuppressive effect, impairing clearance of the virus and permitting persistence. TP53 mutation is characteristic of HPV-negative tumours driven by E6-independent pathways, and HPV integration is a viral event, not something tobacco induces directly.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.