Which factor contributes to the increased risk of squamous cell carcinoma of the cervix among smokers, independently of HPV status?

• A Direct carcinogenic effect of tar on the ectocervical squamous epithelium
• B Nicotine metabolites concentrated in cervical mucus causing local immunosuppression and DNA adduct formation ✓
• C Induction of hepatic cytochrome enzymes that activate circulating procarcinogens
• D Chronic cough leading to raised intra-abdominal pressure and cervical eversion

Explanation

Smoking roughly doubles the risk of cervical squamous carcinoma in HPV-infected women. Nicotine and its metabolite cotinine are measurable in cervical mucus at concentrations higher than in serum, producing local immunosuppression (reduced Langerhans cells) and DNA adducts that cooperate with HPV E6/E7 effects. Option A fails because the epithelial damage is mediated by secreted metabolites, not direct tar contact. Hepatic enzyme induction (C) affects oestrogen metabolism, not cervical carcinogenesis.

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.