Socio Demographic and Reproductive Risk Factors for Cervical Cancer – a Large Prospective Cohort Study from Rural India

Background: India shows some of the highest rates of cervical cancer worldwide, and more than 70% of thepopulation is living in rural villages. Prospective cohort studies to determine the risk factors for cervical cancerare very rare from low and medium resource countries. The aim of this study was to quantify the effect of riskfactors related to cervical cancer in a rural setting in South India. Material and methods: Sociodemographic andreproductive potential risk factors for cervical cancer were studied using the data from a cohort of 30,958 womenwho constituted the unscreened control group in a randomised screening trial in Dindigul district, Tamilnadu,India. The analysis was accomplished with the Cox proportional hazard regression model.
Results: Women ofincreasing age (HR=2.4; 95% CI: 1.6, 3.8 in 50-59 vs 30-39), having many pregnancies (HR=7.1; 1.0, 52 in 4+ vs0) and no education (HR=0.6; 0.2, 0.7 in high vs none) were found to be at significantly increased risk of cervicalcancer.
Conclusion: This cohort study gives very strong evidence to say that education is the fundamental factoramong the sociodemographic and reproductive determinants of cervical cancer in low resource settings. Publicawareness through education and improvements in living standards can play an important role in reducing thehigh incidence of cervical cancer in India. These findings further stress the importance of formulating publichealth policies aimed at increasing awareness and implementation of cervical cancer screening programmes.