Cancer Causes & Control

, Volume 24, Issue 7, pp 1449–1457 | Cite as

Cervical screening, high-grade squamous lesions, and cervical cancer in illicit drug users

  • Anne Kricker
  • Lucinda Burns
  • Chris Goumas
  • Bruce K. Armstrong
Original paper


Background and purpose

Women who use illicit drugs (“drug users”) are exposed to human papillomaviruses (HPVs) from lifestyle risks that include sex risk behaviors, human immunodeficiency virus infection, and high levels of tobacco smoking. Both HPVs and tobacco smoking are recognized causes of cervical cancer, but little is known about risk in drug users. We sought to examine risk of cervical neoplasia and to estimate cervical screening prevalence in drug users compared to non-drug-users in Australia.


Our study linked hospital admission records of women aged 20–54 in 2000–2007 to Pap Test Register and Cancer Registry records for 19,699 with an illicit drug–related admission and 194,089 without. We designed a nested case–control study of risk of cervical intraepithelial neoplasia (CIN) 2/3 and cervical cancer and a cross-sectional study of screening prevalence in this cohort of women.


Drug users were less likely than non-users to be screened in the past 3 years (crude prevalence 47 vs 58 %; prevalence ratio 0.80; 95 % CI 0.78–0.81). Odds ratios (ORs) in drug users, adjusted for cervical screening history and smoking, were 1.13 (95 % CI 1.04–1.23) for CIN 2/3 and 1.43 (95 % CI 0.96–2.15) for cervical cancer. The adjusted ORs in each case were similar in cannabinoid users and users of other drugs.


The increased risks of CIN 2/3 and cervical cancer we observed are probably due to sex risk behaviors and their associated high risk of HPV. Interventions in drug users, such as HPV vaccination and barrier contraception and more cervical screening, might reduce the risk of cervical neoplasia.


Illicit drug users Cervical cancer CIN 2/3 Cervical screening 



Funding sources were a University of Sydney data linkage grant and a grant from the Mental Health and Drug & Alcohol Office, NSW Health.


  1. 1.
    Australian Institute of Health and Welfare (2007) Statistics on drug use in Australia 2006. AIHW, CanberraGoogle Scholar
  2. 2.
    Turner C, Russell A, Brown W (2003) Prevalence of illicit drug use in young Australian women, patterns of use and associated risk factors. Addiction 98(10):1419–1426PubMedCrossRefGoogle Scholar
  3. 3.
    Roxburgh A, Degenhardt L (2008) Characteristics of drug-related hospital separations in Australia. Drug Alcohol Depend 92(1–3):149–155PubMedCrossRefGoogle Scholar
  4. 4.
    Smith AM, Ferris JA, Simpson JM, Shelley J, Pitts MK, Richters J (2010) Cannabis use and sexual health. J Sex Med 7(2 Pt 1):787–793PubMedCrossRefGoogle Scholar
  5. 5.
    International Agency for Research on Cancer (1995) Human Papillomaviruses, vol 64. International Agency for Research on Cancer, LyonGoogle Scholar
  6. 6.
    International Agency for Research on Cancer (2007) Human Papillomaviruses, vol 90. International Agency for Research on Cancer, LyonGoogle Scholar
  7. 7.
    Bosch FX, de Sanjose S (2007) The epidemiology of human papillomavirus infection and cervical cancer. Dis Markers 23(4):213–227PubMedGoogle Scholar
  8. 8.
    Plummer M, Schiffman M, Castle PE, Maucort-Boulch D, Wheeler CM (2007) A 2-year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion. J Infect Dis 195(11):1582–1589PubMedCrossRefGoogle Scholar
  9. 9.
    Moscicki AB, Hills N, Shiboski S et al (2001) Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females. JAMA 285(23):2995–3002PubMedCrossRefGoogle Scholar
  10. 10.
    Vaccarella S, Franceschi S, Herrero R et al (2006) Sexual behavior, condom use, and human papillomavirus: pooled analysis of the IARC human papillomavirus prevalence surveys. Cancer Epidemiol Biomarkers Prev 15(2):326–333PubMedCrossRefGoogle Scholar
  11. 11.
    Vaccarella S, Herrero R, Snijders PJ et al (2008) Smoking and human papillomavirus infection: pooled analysis of the International Agency for Research on Cancer HPV Prevalence Surveys. Int J Epidemiol 37(3):536–546PubMedCrossRefGoogle Scholar
  12. 12.
    International Collaboration of Epidemiological Studies of Cervical Cancer (2006) Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer 118(6):1481–1495CrossRefGoogle Scholar
  13. 13.
    Iversen J, Topp L, Maher L (2011) Australian NSP survey National Data Report 1995–2010. The Kirby Institute, UNSW, EnglandGoogle Scholar
  14. 14.
    Ramsey SE, Bell KM, Engler-Field PA (2010) HIV risk behavior among female substance abusers. J Addict Dis 29(2):192–199CrossRefGoogle Scholar
  15. 15.
    Taylor R, Morrell S, Mamoon H, Wain G, Ross J (2006) Decline in cervical cancer incidence and mortality in New South Wales in relation to control activities (Australia). Cancer Causes Control 17(3):299–306PubMedCrossRefGoogle Scholar
  16. 16.
    Canfell K, Sitas F, Beral V (2006) Cervical cancer in Australia and the United Kingdom: comparison of screening policy and uptake, and cancer incidence and mortality. Med J Aust 185(9):482–486PubMedGoogle Scholar
  17. 17.
    Alam N, Banks C, Chen W, Baker D, Kwaan G, Bishop J (2008) Cervical cancer screening in New South Wales: annual statistical report 2005. Cancer Institute NSW, SydneyGoogle Scholar
  18. 18.
    Australian Institute of Health and Welfare (2011) Cervical screening in Australia 2008–2009. CAN 57. AIHW, CanberraGoogle Scholar
  19. 19.
    Australian Institute of Health and Welfare (2007) Cervical screening in Australia 2004–2005. CAN 33. AIHW, CanberraGoogle Scholar
  20. 20.
    Reece A (2007) Lifetime prevalence of cervical neoplasia in addicted and medical patients. Aust N Z J Obstet Gynaecol 47(5):419–423PubMedCrossRefGoogle Scholar
  21. 21.
    Syrjanen K, Naud P, Derchain S et al (2008) Drug addiction is not an independent risk factor for oncogenic human papillomavirus infections or high-grade cervical intraepithelial neoplasia: case-control study nested within the Latin American Screening study cohort. Int J STD AIDS 19(4):251–258PubMedCrossRefGoogle Scholar
  22. 22.
    D’Souza G, Palefsky JM, Zhong Y et al (2010) Marijuana use is not associated with cervical human papillomavirus natural history or cervical neoplasia in HIV-seropositive or HIV-seronegative women. Cancer Epidemiol Biomarkers Prev 19(3):869–872PubMedCrossRefGoogle Scholar
  23. 23.
    Sidney S, Quesenberry CP Jr, Friedman GD, Tekawa IS (1997) Marijuana use and cancer incidence (California, United States). Cancer Causes Control 8(5):722–728PubMedCrossRefGoogle Scholar
  24. 24.
    Lawrence G, Dinh I, Taylor L (2008) The centre for health record linkage: a new resource for health services research and evaluation. HIM J 37(2):60–62Google Scholar
  25. 25.
    Kelman CW, Bass AJ, Holman CD (2002) Research use of linked health data: a best practice protocol. Aust N Z J Public Health 26(3):251–255PubMedCrossRefGoogle Scholar
  26. 26.
    Richardson DB (2004) An incidence density sampling program for nested case-control analyses. Occup Environ Med 61(12):e59PubMedCrossRefGoogle Scholar
  27. 27.
    International Agency for Research on Cancer (2002) Tobacco Smoking and tobacco smoke, vol 38. IARC, LyonGoogle Scholar
  28. 28.
    McDermott L, Dobson A, Owen N (2009) Determinants of continuity and change over 10 years in young women’s smoking. Addiction 104(3):478–487PubMedCrossRefGoogle Scholar
  29. 29.
    Australian Bureau of Statistics (2006) SEIFA: Socio-Economic Indexes for Areas. Australia, 2006. Australian Bureau of Statistics, CanberraGoogle Scholar
  30. 30.
    McKnight B, McKnight I, Kerr T, Li K, Montaner J, Wood E (2006) Prevalence and correlates of cervical cancer screening among injection drug users. J Obstet Gynaecol Can 28(8):695–699PubMedGoogle Scholar
  31. 31.
    Morrell S, Perez DA, Hardy M, Cotter T, Bishop JF (2010) Outcomes from a mass media campaign to promote cervical screening in NSW, Australia. J Epidemiol Community Health 64(9):777–783PubMedCrossRefGoogle Scholar
  32. 32.
    Taylor RJ, Mamoon HA, Morrell SL, Wain GV (2001) Cervical screening by socio-economic status in Australia. Aust N Z J Public Health 25(3):256–260PubMedCrossRefGoogle Scholar
  33. 33.
    Lofters AK, Moineddin R, Hwang SW, Glazier RH (2011) Predictors of low cervical cancer screening among immigrant women in Ontario, Canada. BMC Womens Health 11:20PubMedCrossRefGoogle Scholar
  34. 34.
    Lofters AK, Hwang SW, Moineddin R, Glazier RH (2010) Cervical cancer screening among urban immigrants by region of origin: a population-based cohort study. Prev Med 51(6):509–516PubMedCrossRefGoogle Scholar
  35. 35.
    Day NE (1986) The epidemiological basis for evaluating different screening policies. In: Hakama M, Miller AB, Day NE (eds) Screening for cancer of the uterine cervix. International Agency for Research on Cancer, Lyon, pp 199–212Google Scholar
  36. 36.
    Brooks A, Meade CS, Potter JS, Lokhnygina Y, Calsyn DA, Greenfield SF (2010) Gender differences in the rates and correlates of HIV risk behaviors among drug abusers. Subst Use Misuse 45(14):2444–2469PubMedCrossRefGoogle Scholar
  37. 37.
    Strickler HD, Burk RD, Fazzari M et al (2005) Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus-positive women. J Natl Cancer Inst 97(8):577–586PubMedCrossRefGoogle Scholar
  38. 38.
    Massad LS, Seaberg EC, Wright RL et al (2008) Squamous cervical lesions in women with human immunodeficiency virus: long-term follow-up. Obstet Gynecol 111(6):1388–1393PubMedCrossRefGoogle Scholar
  39. 39.
    Lawrinson P, Ali R, Buavirat A et al (2008) Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS. Addiction 103(9):1484–1492PubMedCrossRefGoogle Scholar
  40. 40.
    National Centre in HIV Epidemiology and Clinical Research (2005) HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2005. National Centre in HIV Epidemiology and Clinical Research, SydneyGoogle Scholar
  41. 41.
    National Centre in HIV Epidemiology and Clinical Research (2008) Australian NSP Survey National Data Report 2003–2007. National Centre in HIV Epidemiology and Clinical Research, SydneyGoogle Scholar
  42. 42.
    Australian Institute of Health and Welfare (2005) 2004 National drug strategy household survey: State and territory supplement. PHE 61. AIHW, CanberraGoogle Scholar
  43. 43.
    Miller M, Draper G (2001) Statistics on drug use in Australia. PHE 30. AIHW, CanberraGoogle Scholar
  44. 44.
    Australian Institute of Health and Welfare (2005) Statistics on drug use in Australia 2004. PHE 62. AIHW, CanberraGoogle Scholar
  45. 45.
    Ridolfo B, Stevenson C (2001) The quantification of drug-caused mortality and morbidity in Australia, 1998. PHE 29. Australian Institute of Health and Welfare, CanberraGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Anne Kricker
    • 1
  • Lucinda Burns
    • 2
  • Chris Goumas
    • 1
  • Bruce K. Armstrong
    • 1
  1. 1.Sydney School of Public HealthUniversity of SydneySydneyAustralia
  2. 2.National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia

Personalised recommendations