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Frauenheilkunde up2date 2019; 13(01): 23-36
DOI: 10.1055/a-0662-0845
Gynäkologische Onkologie
Georg Thieme Verlag KG Stuttgart · New York

Primäre Prävention – Mamma- und Genitalkarzinome

Caroline Preuß
,
Felix Heindl
,
Alexander Hein
,
Martin C. Koch
,
Paul Gaß
,
Matthias W. Beckmann
,
Michael P. Lux
,
Julius Emons
Further Information

Publication History

Publication Date:
08 February 2019 (online)

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In den letzten Jahren haben sich Diagnostik und Therapie im Bereich der gynäkologischen Onkologie und Senologie stetig weiterentwickelt. Dennoch ist das Versterben an einer Krebserkrankung in den hoch entwickelten Ländern eine der häufigsten Todesursachen der Frau [1]. Maßnahmen zur Primärprävention sind daher von hoher Bedeutung, um die Morbidität und Mortalität von Krebserkrankungen zu senken.
Kernaussagen

  • Ein Teil der gynäkologischen Krebserkrankungen wird von vermeidbaren Risikofaktoren gefördert. Hierzu gehören Infektionskrankheiten, Umweltfaktoren, schlecht eingestellter Diabetes mellitus Typ 2 und ein ungesunder Lebensstil, insbesondere Nikotin- und Alkoholkonsum, Adipositas, ungesunde Ernährung und geringe körperliche Aktivität.

  • Maßnahmen der Primärprävention können den Einfluss der modifizierbaren Risikofaktoren einschränken oder ganz unterbinden.

  • Für das Mamma- und Ovarialkarzinom wirken z. B. Schwangerschaft und Stillen protektiv. Bei positiver Familienanamnese sowie bei hohem Erkrankungsrisiko kann eine genetische Testung das Erkrankungsrisiko abklären mit entsprechenden Vorsorgemaßnahmen je nach Befund.

  • Beim Mammakarzinom wirkt bei hohem Risiko die Prävention mit Tamoxifen präventiv, beim Ovarialkarzinom eine Sterilisation mit Tubenligatur oder Salpingektomie.

  • Für das Endometriumkarzinom wirken neben den allgemeinen Maßnahmen zum Lebensstil auch Intrauterinpessare und orale Kontrazeptiva risikoreduzierend.

  • Die effektivste Maßnahme der Primärprävention für das Zervixkarzinom besteht in der Impfung gegen mehrere Varianten des humanen Papillomvirus (HPV), andernfalls der Gebrauch von Kondomen.

Schlüsselwörter

Primäre Prävention - Mammakarzinom - Zervixkarzinom - Ovarialkarzinom - Endometriumkarzinom
 

  • Literatur

  • 1 Bray F, Ferlay J, Soerjomataram I. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424 doi:10.3322/caac.21492
    CrossrefPubMedGoogle Scholar
  • 2 Gredner T, Behrens G, Stock C. et al. Krebs durch Infektionen und ausgewählte Umweltfaktoren. Dtsch Arztebl Int 2018; 115: 586-593
    PubMedGoogle Scholar
  • 3 Behrens G, Gredner T, Stock C. et al. Krebs durch Übergewicht, geringe körperliche Aktivität und ungesunde Ernährung. Dtsch Arztebl Int 2018; 115: 578-585
    CrossrefPubMedGoogle Scholar
  • 4 WHO, EMRO. Health Promotion and Disease Prevention through population-based Interventions, including Action to address social Determinants and Health Inequity. Kairo: WHO – EMRO; 2018
    Google Scholar
  • 5 Robert-Koch-Institut, Zentrum für Krebsregisterdaten 2017. Im Internet: https://www.krebsdaten.de/Krebs/DE/Content/Krebsarten/Brustkrebs/brustkrebs.html Stand: 10.01.2019
    PubMed
  • 6 Arbeitsgemeinschaft Gynäkologische Onkologie AGO, Kommission Mamma. Diagnosis and treatment of patients with primary and metastatic breast cancer. Recommendations 2018. Im Internet: https://www.ago-online.de/fileadmin/downloads/leitlinien/mamma/2018-03/EN/Gesamt_PDF_Englisch/Updated_Guidelines_2018.pdf Stand 10.01.2019
    PubMedGoogle Scholar
  • 7 Kast K, Rhiem K, Wappenschmidt B. et al. Prevalence of BRCA1/2 germline mutations in 21 401 families with breast and ovarian cancer. J Med Genet 2016; 53: 465-471
    CrossrefPubMedGoogle Scholar
  • 8 Kuchenbaecker KB, Hopper JL, Barnes DR. et al. Risks of breast, ovarian, and contralateral breast cancer for brca1 and brca2 mutation carriers. JAMA 2017; 317: 2402-2416
    CrossrefPubMedGoogle Scholar
  • 9 Rhiem K, Schmutzler R. Impact of prophylactic mastectomy in BRCA1/2 mutation carriers. Breast Care (Basel) 2014; 9: 385-389
    CrossrefPubMedGoogle Scholar
  • 10 Rebbeck TR, Friebel T, Lynch HT. et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol 2004; 22: 1055-1062
    CrossrefPubMedGoogle Scholar
  • 11 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, D.K., AWMF), S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Mammakarzinoms. 2018. Version 4.1. Im Internet: https://www.leitlinienprogramm-onkologie.de/leitlinien/mammakarzinom/ Stand 10.01.2019
    PubMedGoogle Scholar
  • 12 Kauff ND, Domchek SM, Friebel TM. et al. Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: A multicenter, prospective study. J Clin Oncol 2008; 26: 1331-1337
    CrossrefPubMedGoogle Scholar
  • 13 Domchek SM, Friebel TM, Neuhausen SL. et al. Mortality after bilateral salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers: a prospective cohort study. Lancet Oncol 2006; 7: 223-229
    CrossrefPubMedGoogle Scholar
  • 14 Metcalfe K, Lynch HT, Ghadirian P. et al. Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. J Clin Oncol 2004; 22: 2328-2335
    CrossrefPubMedGoogle Scholar
  • 15 Domchek SM, Friebel TM, Singer CF. et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 2010; 304: 967-975
    CrossrefPubMedGoogle Scholar
  • 16 Finch AP, Lubinski J, Møller P. et al. Impact of oophorectomy on cancer incidence and mortality in women with a BRCA1 or BRCA2 mutation. J Clin Oncol 2014; 32: 1547-1553
    CrossrefPubMedGoogle Scholar
  • 17 Picon-Ruiz M, Morata-Tarifa C, Valle-Goffin JJ. et al. Obesity and adverse breast cancer risk and outcome: Mechanistic insights and strategies for intervention. CA Cancer J Clin 2017; 67: 378-397
    CrossrefPubMedGoogle Scholar
  • 18 Renehan AG, Tyson M, Egger M. et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008; 371: 569-578
    CrossrefPubMedGoogle Scholar
  • 19 Colditz GA, Hankinson SE. The Nursesʼ Health Study: lifestyle and health among women. Nature Rev Cancer 2005; 5: 388-396
    CrossrefPubMedGoogle Scholar
  • 20 Benson JR, Jatoi I. Tailoring breast cancer therapies to reduce mortality and improve quality of life: San Antonio Breast Cancer Symposium 2017 (part 2). Future Oncol 2018; 14: 1893-1896
    CrossrefPubMedGoogle Scholar
  • 21 Keum N, Greenwood DC, Lee DH. et al. Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies. J Natl Cancer Inst 2015; 107: pii:djv088 doi:10.1093/jnci/djv088
    CrossrefPubMedGoogle Scholar
  • 22 Fisher B, Costantino JP, Wickerham DL. et al. Tamoxifen for prevention of breast cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 1998; 90: 1371-1388
    CrossrefPubMedGoogle Scholar
  • 23 Zenda S, Yamaguchi T, Yokota T. et al. Topical steroid versus placebo for the prevention of radiation dermatitis in head and neck cancer patients receiving chemoradiotherapy: the study protocol of J-SUPPORT 1602 (TOPICS study), a randomized double-blinded phase 3 trial. BMC Cancer 2018; 18: 873
    CrossrefPubMedGoogle Scholar
  • 24 Cummings SR, Eckert S, Krueger KA. et al. The effect of raloxifene on risk of breast cancer in postmenopausal women – Results from the MORE randomized trial. JAMA 1999; 281: 2189-2197
    CrossrefPubMedGoogle Scholar
  • 25 Martín-Sánchez JC, Lunet N, González-Marrón A. et al. Projections in breast and lung cancer mortality among women: A Bayesian analysis of 52 countries worldwide. Cancer Res 2018; 78: 4436-4442
    CrossrefPubMedGoogle Scholar
  • 26 Goss PE, Ingle JN, Alés-Martínez JE. et al. Exemestane for Breast-Cancer Prevention in Postmenopausal Women. N Engl J Med 2011; 364: 2381-2391
    CrossrefPubMedGoogle Scholar
  • 27 Izumi H, Yamasaki A, Takeda K. et al. Acute-phase reaction induced by zoledronate and its effect on prognosis of patients with advanced non-small cell lung cancer. Lung Cancer 2018; 122: 200-205
    CrossrefPubMedGoogle Scholar
  • 28 WHO. IARC monographs on the evaluation of carcinogenic risks to humans. Hormonal Contraception and Post-menopausal Hormonal Therapy. Lyon (FR): International Agency for Research on Cancer 1999; No. 72. Im Internet: https://monographs.iarc.fr/wp-content/uploads/2018/06/mono72.pdf Stand: 10.01.2019
    PubMedGoogle Scholar
  • 29 Beral V, Doll R, Hermon C. et al. Collaborative Group on Epidemiological Studies of Ovarian Cancer. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet 2008; 371: 303-314
    CrossrefPubMedGoogle Scholar
  • 30 Cibula D, Widschwendter M, Májek O. et al. Tubal ligation and the risk of ovarian cancer: review and meta-analysis. Hum Reprod Update 2011; 17: 55-67
    CrossrefPubMedGoogle Scholar
  • 31 Rice MS, Hankinson SE, Tworoger SS. Tubal ligation, hysterectomy, unilateral oophorectomy, and risk of ovarian cancer in the Nursesʼ Health Studies. Fertil Steril 2014; 102: 192-198.e3
    CrossrefPubMedGoogle Scholar
  • 32 Rice MS, Murphy MA, Vitonis AF. et al. Tubal ligation, hysterectomy and epithelial ovarian cancer in the New England Case-Control Study. Int J Cancer 2013; 133: 2415-2421
    CrossrefPubMedGoogle Scholar
  • 33 Gaitskell K, Green J, Pirie K. et al. Tubal ligation and ovarian cancer risk in a large cohort: Substantial variation by histological type. Int J Cancer 2016; 138: 1076-1084
    CrossrefPubMedGoogle Scholar
  • 34 Sieh W, Salvador S, McGuire V. et al. Tubal ligation and risk of ovarian cancer subtypes: a pooled analysis of case-control studies. Int J Epidemiol 2013; 42: 579-589
    CrossrefPubMedGoogle Scholar
  • 35 Pölcher M, Hauptmann S, Fotopoulou C. et al. Should fallopian tubes be removed during hysterectomy procedures? – A statement by AGO Ovar. Geburtshilfe Frauenheilk 2015; 75: 339-341
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 AWMF. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, D.K., AWMF), S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren. 2017. Langversion 2.0. Im Internet: https://www.awmf.org/uploads/tx_szleitlinien/032-035-OLl_Ovarialkarzinom_2017-11.pdf Stand: 12.01.2019
    PubMedGoogle Scholar
  • 37 Falconer H, Yin L, Grönberg H. et al. Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst 2015; 107: pii:dju410 doi:10.1093/jnci/dju410
    CrossrefPubMedGoogle Scholar
  • 38 Pölcher M, Hauptmann S, Fotopoulou C. et al. Opportunistic salpingectomies for the prevention of a high-grade serous carcinoma: a statement by the Kommission Ovar of the AGO. Arch Gynecol Obstet 2015; 292: 231-234
    CrossrefPubMedGoogle Scholar
  • 39 Anderson GL, Judd HL, Kaunitz AM. et al. Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Womenʼs Health Initiative randomized trial. JAMA 2003; 290: 1739-1748
    CrossrefPubMedGoogle Scholar
  • 40 Beral V. Million Women Study Collaborators, Bull D, Green J, Reeves G. Ovarian cancer and hormone replacement therapy in the Million Women Study. Lancet 2007; 369: 1703-1710
    CrossrefPubMedGoogle Scholar
  • 41 Mørch LS, Løkkegaard E, Andreasen AH. et al. Hormone therapy and ovarian cancer. JAMA 2009; 302: 298-305
    CrossrefPubMedGoogle Scholar
  • 42 Collaborative Group on Epidemiological Studies of Ovarian. Beral V, Gaitskell K, Hermon C. Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies. Lancet 2015; 385: 1835-1842
    CrossrefPubMedGoogle Scholar
  • 43 Beavis AL, Smith AJ, Fader AN. Lifestyle changes and the risk of developing endometrial and ovarian cancers: opportunities for prevention and management. Int J Womens Health 2016; 8: 151-167
    PubMedGoogle Scholar
  • 44 Jordan SJ, Green AC, Whiteman DC. et al. Serous ovarian, fallopian tube and primary peritoneal cancers: a comparative epidemiological analysis. Int J Cancer 2008; 122: 1598-1603
    PubMedGoogle Scholar
  • 45 Cetin I, Cozzi V, Antonazzo P. Infertility as a cancer risk factor – a review. Placenta 2008; 29 Suppl B: 169-177
    CrossrefPubMedGoogle Scholar
  • 46 Leitzmann MF, Koebnick C, Danforth KN. et al. Body mass index and risk of ovarian cancer. Cancer 2009; 115: 812-822
    CrossrefPubMedGoogle Scholar
  • 47 Liu Z, Zhang TT, Zhao JJ. et al. The association between overweight, obesity and ovarian cancer: a meta-analysis. Jpn J Clin Oncol 2015; 45: 1107-1115
    PubMedGoogle Scholar
  • 48 Bandera EV, Qin B, Moorman PG. et al. Obesity, weight gain, and ovarian cancer risk in African American women. Int J Cancer 2016; 139: 593-600
    CrossrefPubMedGoogle Scholar
  • 49 Dixon SC, Nagle CM, Thrift AP. et al. Adult body mass index and risk of ovarian cancer by subtype: a Mendelian randomization study. Int J Epidemiol 2016; 45: 884-895
    CrossrefPubMedGoogle Scholar
  • 50 Marchetti C, De Felice F, Palaia I. et al. Risk-reducing salpingo-oophorectomy: a meta-analysis on impact on ovarian cancer risk and all cause mortality in BRCA 1 and BRCA 2 mutation carriers. BMC Womens Health 2014; 14: 150
    CrossrefPubMedGoogle Scholar
  • 51 Rebbeck TR, Lynch HT, Neuhausen SL. et al. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 2002; 346: 1616-1622
    CrossrefPubMedGoogle Scholar
  • 52 Haber D. Prophylactic oophorectomy to reduce the risk of ovarian and breast cancer in carriers of BRCA mutations. N Engl J Med 2002; 346: 1660-1662
    CrossrefPubMedGoogle Scholar
  • 53 Finch A, Beiner M, Lubinski J. et al. Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 Mutation. JAMA 2006; 296: 185-192
    CrossrefPubMedGoogle Scholar
  • 54 Kotsopoulos J, Gronwald J, Karlan B. et al. Age-specific ovarian cancer risks among women with a BRCA1 or BRCA2 mutation. Gynecol Oncol 2018; 150: 85-91
    CrossrefPubMedGoogle Scholar
  • 55 Marchetti C, De Felice F, Palaia I. et al. Risk-reducing salpingo-oophorectomy: a meta-analysis on impact on ovarian cancer risk and all cause mortality in BRCA 1 and BRCA 2 mutation carriers. BMC Womens Health 2014; 14: 150
    CrossrefPubMedGoogle Scholar
  • 56 Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2014; 20: 748-758
    CrossrefPubMedGoogle Scholar
  • 57 Beral V, Bull D, Reeves G. Endometrial cancer and hormone-replacement therapy in the Million Women Study. Lancet 2005; 365: 1543-1551
    CrossrefPubMedGoogle Scholar
  • 58 Allen NE, Tsilidis KK, Key TJ. et al. Menopausal hormone therapy and risk of endometrial carcinoma among postmenopausal women in the European Prospective Investigation Into Cancer and Nutrition. Am J Epidemiol 2010; 172: 1394-1403
    CrossrefPubMedGoogle Scholar
  • 59 Razavi P, Pike MC, Horn-Ross PL. et al. Long-term postmenopausal hormone therapy and endometrial cancer. Cancer Epidemiol Biomarkers Prev 2010; 19: 475-483
    CrossrefPubMedGoogle Scholar
  • 60 Chlebowski RT, Anderson GL, Sarto GE. et al. Continuous combined estrogen plus progestin and endometrial cancer: The Womenʼs Health Initiative Randomized Trial. J Natl Cancer Inst 2016; 108: pii:djv350 doi:10.1093/jnci/djv350
    CrossrefPubMedGoogle Scholar
  • 61 Lacey jr. JV, Brinton LA, Lubin JH. et al. Endometrial carcinoma risks among menopausal estrogen plus progestin and unopposed estrogen users in a cohort of postmenopausal women. Cancer Epidemiol Biomarkers Prev 2005; 14: 1724-1731
    CrossrefPubMedGoogle Scholar
  • 62 AWMF. Leitlinienprogramm Onkologie (Deutsche Krebshilfe, AWMF), Diagnostik, Therapie und Nachsorge der Patientinnen mit Endometriumkarzinom. 2018. Langversion 1.0. Im Internet: https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Endometriumkarzinom/LL_Endometriumkarzinom_Langversion_1.0.pdf Stand: 12.01.2019
    PubMedGoogle Scholar
  • 63 Nelson HD, Smith ME, Griffin JC. et al. Use of medications to reduce risk for primary breast cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2013; 158: 604-614
    CrossrefPubMedGoogle Scholar
  • 64 Braithwaite RS, Chlebowski RT, Lau J. et al. Meta-analysis of vascular and neoplastic events associated with tamoxifen. J Gen Intern Med 2003; 18: 937-947
    CrossrefPubMedGoogle Scholar
  • 65 Al-Mubarak M, Tibau A, Templeton AJ. et al. Extended adjuvant tamoxifen for early breast cancer: a meta-analysis. PLoS One 2014; 9: e88238
    CrossrefPubMedGoogle Scholar
  • 66 DeMichele A, Troxel AB, Berlin JA. et al. Impact of raloxifene or tamoxifen use on endometrial cancer risk: a population-based case-control study. J Clin Oncol 2008; 26: 4151-4159
    CrossrefPubMedGoogle Scholar
  • 67 Collaborative Group on Epidemiological Studies on Endometrial Cancer. Endometrial cancer and oral contraceptives: an individual participant meta-analysis of 27 276 women with endometrial cancer from 36 epidemiological studies. Lancet Oncol 2015; 16: 1061-1070
    CrossrefPubMedGoogle Scholar
  • 68 Gierisch JM, Coeytaux RR, Urrutia RP. et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiol Biomarkers Prev 2013; 22: 1931-1943
    CrossrefPubMedGoogle Scholar
  • 69 Parazzini F, Pelucchi C, Talamini R. et al. Use of fertility drugs and risk of endometrial cancer in an Italian case-control study. Eur J Cancer Prev 2010; 19: 428-430
    CrossrefPubMedGoogle Scholar
  • 70 Siristatidis C, Sergentanis TN, Kanavidis P. et al. Controlled ovarian hyperstimulation for IVF: impact on ovarian, endometrial and cervical cancer-a systematic review and meta-analysis. Hum Reprod Update 2013; 19: 105-123
    CrossrefPubMedGoogle Scholar
  • 71 Soini T, Hurskainen R, Grénman S. et al. Cancer risk in women using the levonorgestrel-releasing intrauterine system in Finland. Obstet Gynecol 2014; 124 (2 Pt 1): 292-299
    CrossrefPubMedGoogle Scholar
  • 72 Felix AS, Gaudet MM, La Vecchia C. et al. Intrauterine devices and endometrial cancer risk: a pooled analysis of the Epidemiology of Endometrial Cancer Consortium. Int J Cancer 2015; 136: E410-22
    CrossrefPubMedGoogle Scholar
  • 73 Win AK, Reece JC, Ryan S. Family history and risk of endometrial cancer: a systematic review and meta-analysis. Obstet Gynecol 2015; 125: 89-98
    CrossrefPubMedGoogle Scholar
  • 74 Walboomers JM, Jacobs MV, Manos MM. et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999; 189: 12-19
    CrossrefPubMedGoogle Scholar
  • 75 Burchell AN, Winer RL, de Sanjosé S. et al. Chapter 6: Epidemiology and transmission dynamics of genital HPV infection. Vaccine 2006; 24 Suppl 3: S3/52-61
    PubMedGoogle Scholar
  • 76 Robert Koch-Institut. Epidemiologisches Bulletin Nr. 26. Berlin: RKI; 2018
    Google Scholar
  • 77 Harper DM, Franco EL, Wheeler CM. et al. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet 2006; 367: 1247-1255
    CrossrefPubMedGoogle Scholar
  • 78 Smith JF, Brownlow M, Brown M. et al. Antibodies from women immunized with Gardasil cross-neutralize HPV 45 pseudovirions. Hum Vaccines 2007; 3: 109-115
    CrossrefPubMedGoogle Scholar
  • 79 Gadducci A, Barsotti C, Cosio S. et al. Smoking habit, immune suppression, oral contraceptive use, and hormone replacement therapy use and cervical carcinogenesis: a review of the literature. Gynecol Endocrinol 2011; 27: 597-604
    CrossrefPubMedGoogle Scholar
  • 80 Plummer M, Herrero R, Franceschi S. et al. Smoking and cervical cancer: pooled analysis of the IARC multi-centric case-control study. Cancer Causes Control 2003; 14: 805-814
    CrossrefPubMedGoogle Scholar
  • 81 Castellsagué X, Muñoz N. Chapter 3: Cofactors in human papillomavirus carcinogenesis–role of parity, oral contraceptives, and tobacco smoking. J Natl Cancer Inst Monogr 2003; 31: 20-28
    Google Scholar
  • 82 Jensen KE, Schmiedel S, Norrild B. et al. Parity as a cofactor for high-grade cervical disease among women with persistent human papillomavirus infection: a 13-year follow-up. Br J Cancer 2012; 108: 234-239
    PubMedGoogle Scholar
  • 83 Castle PE. How does tobacco smoke contribute to cervical carcinogenesis?. J Virol 2008; 82: 6084-6086
    CrossrefPubMedGoogle Scholar
  • 84 International Collaboration of Epidemiological Studies of Cervical Cancer. Appleby P, Beral V, Berrington de González A. et al. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet 2007; 370: 1609-1621
    CrossrefPubMedGoogle Scholar
  • 85 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, D.K., AWMF), S3-Leitlinie Diagnostik, Therapie und Nachsorge der Patientin mit Zervixkarzinom 2014. Langversion 1.0. Im Internet: https://www.awmf.org/uploads/tx_szleitlinien/032-033OLl_S3_Zervixkarzinom_2014-10.pdf Stand: 12.01.2019
    PubMedGoogle Scholar