A 35-year-old nulliparous, mildly obese woman is diagnosed with cervical intraepithelial neoplasia III. She has been sexually active for 15 years and has had 4 lifetime partners. She has been monogamous with her current partner for several months and takes oral contraceptives consistently. The patient does not use condoms and douches regularly to "stay fresh." Menarche occurred at age 9, and her menses recur every 28 days and last 6 days. She had a plantar wart a few years ago but otherwise has no medical problems. She drinks 1-2 glasses of wine every night but does not use tobacco or illicit drugs. The patient's mother had breast cancer at age 42. Which of the following is the most significant factor that predisposed this patient to cervical abnormalities?

Question

A 35-year-old nulliparous, mildly obese woman is diagnosed with cervical intraepithelial neoplasia III.  She has been sexually active for 15 years and has had 4 lifetime partners.  She has been monogamous with her current partner for several months and takes oral contraceptives consistently.  The patient does not use condoms and douches regularly to "stay fresh."  Menarche occurred at age 9, and her menses recur every 28 days and last 6 days.  She had a plantar wart a few years ago but otherwise has no medical problems.  She drinks 1-2 glasses of wine every night but does not use tobacco or illicit drugs.  The patient's mother had breast cancer at age 42.  Which of the following is the most significant factor that predisposed this patient to cervical abnormalities?

Quizplus · Accepted Answer

11ec160b_3ace_1b55_9249_3dc0107657ca_MD0001_00 Squamous cell carcinoma (SCC), the most common type of cervical cancer, arises from the squamocolumnar junction of the endocervix. Cervical intraepithelial neoplasia (CIN) is carcinoma in situ and precedes SCC. CIN represents a wide spectrum of dysplastic changes of the cervical epithelium that occur under the influence of human papillomavirus (HPV) infection. CIN is usually transient in young healthy women. However, patients with persistent HPV infection or untreated high-grade CIN are at risk for invasive cervical cancer. HPV strains 6 and 11 typically cause condylomata acuminata (genital warts) and have low malignancy potential. However, DNA from high-risk strains (ie, 16, 18, and 31) is integrated into the human cell genome, leading to overexpression of viral oncogenes E6 and E7. E6 binds protein p53 and increases its degradation, whereas E7 binds to the retinoblastoma (RB1) gene and displaces transcription factors normally bound by pRB, the tumor suppressor protein product of RB. Risk factors for developing cervical cancer are related to the risk of acquiring HPV infection. Although HPV can be transmitted by skin-to-skin contact, oncogenic strains are spread primarily by sexual contact. Therefore, this patient's most significant risk factors are a history of multiple sexual partners and the lack of barrier contraceptive (eg, condom) use. (Choice A) Alcohol consumption increases the risk of liver and breast cancers, not cervical cancer. (Choices B, F, and G) Nulliparity, early menarche, and obesity increase the risk of endometrial cancer. These factors are associated with increased estrogen stimulation of the endometrium. (Choice C) Family history of breast cancer is a risk factor for developing breast malignancy. Breast cancer is not associated with cervical cancer, as the latter is usually due to a persistent, oncogenic HPV infection. (Choice D) A plantar wart is usually caused by HPV strains 1-4; however, these strains are not typically carcinogenic and are not associated with cervical dysplasia and invasive cervical cancer. (Choice H) Douching is not a risk factor for HPV infection or cervical dysplasia/cancer. However, it is a risk factor for bacterial vaginosis. Douching disturbs the vaginal ecosystem, resulting in overgrowth of Gardnerella vaginalis. Educational objective: Consistent use of barrier contraceptives is extremely important for preventing sexually transmitted infections, including human papillomavirus (HPV). Patients infected with carcinogenic strains of HPV (ie, 16, 18, and 31) are at risk of squamous cell carcinoma of the cervix. __________ References: HPV infection and cervical neoplasia: associated risk factors. (http://www.ncbi.nlm.nih.gov/pubmed/26244052) ACOG Practice Bulletin No.131: Screening for cervical cancer. (http://www.ncbi.nlm.nih.gov/pubmed/23090560)

A 35-Year-Old Nulliparous, Mildly Obese Woman Is Diagnosed with Cervical