Risk factors of invasive cervical cancer in Mali

Background. Cervical cancer is the most common cancer in women in Mali and the second commonest cause of cancer mortality. Methods. As part of an international effort to evaluate the role of human papillomavirus (HPV) in the aetiology of cervical cancer, we conducted a hospital-based case-control study in three medical centres in Bamako during 1994-1995. A total of 82 cases (invasive cervical cancer patients) and 97 controls matched to the cases for age were included. Information on risk factors was collected through personal interview. Serum antibodies to HPV 16, 18 and 31 virus like particles (VLP) were detected using ELISA assays. Polymerase chain reaction was used to detect HPV DNA in frozen biopsies of cases. Results. Human papillomavirus 6, 18, 31 VLP were detected in 60.4% of cases and 45.4% of controls (P = 0.03). Overall, HPV DNA was identified in 96.9% of the cervical cancer cases. Risk factors for cervical cancer were parity > 10 versus <5 children ([odds ratio] OR = 4.8, 95% CI: 1.5-14.7), never having practised vaginal douching (OR = 17.6, 95% CI: 4.2-74.7), re-using home-made feminine napkins (OR = 45.9, 95% CI: 8.8-238.7) and having a husband with more than two wives (OR = 5.3, 95% CI: 1.3-21.3). Conclusions. These data provide further evidence on the role of HPV in cervical cancer and show that high parity and poor genital hygiene conditions were the main co-factors for cervical cancer in this population with prevalent HPV infection.