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Epidemiological characteristics of cervical cancer in Asian populations and risk factor inference based on Mendelian randomization.

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Τίτλος: Epidemiological characteristics of cervical cancer in Asian populations and risk factor inference based on Mendelian randomization.
Συγγραφείς: Wu B; Department of Gynecology, Affiliated Kunshan Hospital of Jiangsu University, Jiangsu University, Suzhou, Jiangsu, China., Liu Q
Πηγή: Medicine [Medicine (Baltimore)] 2026 Oct 02; Vol. 105 (40), pp. e51015.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 2985248R Publication Model: Print Cited Medium: Internet ISSN: 1536-5964 (Electronic) Linking ISSN: 00257974 NLM ISO Abbreviation: Medicine (Baltimore) Subsets: MEDLINE
Imprint Name(s): Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins
Ιατρικοί όροι (MeSH): Uterine Cervical Neoplasms*/epidemiology , Uterine Cervical Neoplasms*/genetics , Asian People*/genetics , Mendelian Randomization Analysis*, Asia/epidemiology ; Smoking/adverse effects ; Smoking/epidemiology ; Humans ; Female ; Risk Factors ; Genome-Wide Association Study ; Incidence ; Prevalence ; Disability-Adjusted Life Years ; East Asian People ; Middle Aged
Περίληψη: This study aimed to systematically investigate the epidemiological distribution characteristics and disease burden of cervical cancer (CC) in Asian populations, and to assess the causal relationship between smoking, a key modifiable risk factor, and the incidence of CC based on genetic evidence, thereby providing a scientific basis for targeted prevention and control strategies in Asia. This study first used the GBD 2021 database to analyze trends in CC incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021 across global, Asian, and East Asian regions, along with age distribution and attributable risk factors. It then applied 2-sample Mendelian randomization (MR) using genome-wide association study (GWAS) data from East Asian populations, with multiple smoking-related behaviors (e.g., current smoking, cigarettes per day, household smoking exposure) as exposures and CC as the outcome. GBD analysis revealed that in 2021, Asia accounted for over half of the global CC disease burden. Although point estimates suggested a potential upward trend in CC burden across Asia from 1990 to 2021, statistical significance was not reached for the overall Asian population. Despite a general decline in the global incidence rate, the incidence in Japan exhibited a statistically supported upward trend, while point estimates in several other East Asian countries also suggested an increase. The peak disease burden was concentrated among women aged 55 to 59 years. Risk attribution analysis indicated that unsafe sexual behavior was the primary attributable factor for CC-related DALYs, while the attributable burden of smoking was significantly higher in Japan than in other regions. However, MR analysis did not identify statistically significant causal associations between any smoking-related exposure factors and CC risk (P-FDR ≥ .05 after false discovery rate correction). Sensitivity analyses revealed no substantial heterogeneity or pleiotropy bias. Asia, particularly East Asia, faces a substantial and potentially growing burden of CC. Causal inference based on genetic data from East Asian populations did not confirm a direct causal relationship between smoking and the incidence of cervical cancer. Future studies with larger genetic samples are needed to further elucidate the precise role of smoking.
(Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, LLC.)
Competing Interests: The authors have no funding and conflicts of interest to declare.
References: Lancet Public Health. 2023 Dec;8(12):e943-e955. (PMID: 38000889)
J Int Med Res. 2025 Oct;53(10):3000605251383687. (PMID: 41062422)
Korean J Fam Med. 2022 May;43(3):168-173. (PMID: 35610963)
Lancet. 2020 Feb 22;395(10224):575-590. (PMID: 32007141)
Cancer Epidemiol. 2023 Jun;84:102353. (PMID: 36989957)
Cancer Commun (Lond). 2025 Feb;45(2):77-109. (PMID: 39611440)
Am J Med. 1997 May 5;102(5A):3-8. (PMID: 9217656)
In Vivo. 2021 Mar-Apr;35(2):1017-1026. (PMID: 33622897)
Public Health Nurs. 2024 Sep-Oct;41(5):1027-1038. (PMID: 39054588)
Biochim Biophys Acta Rev Cancer. 2024 Nov;1879(6):189192. (PMID: 39349261)
J Med Virol. 2025 Feb;97(2):e70238. (PMID: 39963849)
Cancer Res. 2020 Aug 15;80(16):3443-3446. (PMID: 32606005)
Lancet Glob Health. 2023 Feb;11(2):e197-e206. (PMID: 36528031)
Sex Transm Dis. 2014 Nov;41(11):660-4. (PMID: 25299412)
Am J Reprod Immunol. 2024 Sep;92(3):e13922. (PMID: 39268635)
Healthcare (Basel). 2025 Nov 10;13(22):. (PMID: 41302241)
Chin J Cancer Res. 2020 Dec 31;32(6):720-728. (PMID: 33446995)
Chin Med J (Engl). 2021 Jul 14;134(15):1838-1844. (PMID: 34267066)
Lancet Public Health. 2020 Apr;5(4):e223-e234. (PMID: 32057317)
Cancer Biol Med. 2025 Oct 6;22(9):. (PMID: 41054968)
BMJ. 2022 Dec 15;379:e070115. (PMID: 36521855)
Cancer Res Treat. 2024 Jul;56(3):898-908. (PMID: 38228083)
J Virol. 2008 Jan;82(2):1053-8. (PMID: 17989183)
BMJ. 2022 Jul 27;378:e069679. (PMID: 35896191)
Cancer. 2024 Aug 1;130(15):2571-2576. (PMID: 38651760)
Expert Rev Anticancer Ther. 2021 Jul;21(7):781-794. (PMID: 33663309)
JAMA Oncol. 2024 Sep 1;10(9):1237-1244. (PMID: 38990578)
J Matern Fetal Neonatal Med. 2024 Dec;37(1):2294691. (PMID: 38146168)
Nat Rev Cancer. 2021 Oct;21(10):607-608. (PMID: 34376828)
Transl Oncol. 2025 Oct;60:102473. (PMID: 40690821)
Contributed Indexing: Keywords: Asian populations; Mendelian randomization; cervical cancer; disease burden
Entry Date(s): Date Created: 20261002 Date Completed: 20261002 Latest Revision: 20261005
Update Code: 20261005
PubMed Central ID: PMC13632949
DOI: 10.1097/MD.0000000000051015
PMID: 42826328
Βάση Δεδομένων: MEDLINE
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  Data: Epidemiological characteristics of cervical cancer in Asian populations and risk factor inference based on Mendelian randomization.
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  Data: <searchLink fieldCode="AU" term="%22Wu+B%22">Wu B</searchLink>; Department of Gynecology, Affiliated Kunshan Hospital of Jiangsu University, Jiangsu University, Suzhou, Jiangsu, China.<br /><searchLink fieldCode="AU" term="%22Liu+Q%22">Liu Q</searchLink>
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  Data: <searchLink fieldCode="MM" term="%22Uterine+Cervical+Neoplasms%22">Uterine Cervical Neoplasms*</searchLink>/<searchLink fieldCode="MM" term="%22Uterine+Cervical+Neoplasms+epidemiology%22">epidemiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Uterine+Cervical+Neoplasms%22">Uterine Cervical Neoplasms*</searchLink>/<searchLink fieldCode="MM" term="%22Uterine+Cervical+Neoplasms+genetics%22">genetics</searchLink> <br /><searchLink fieldCode="MM" term="%22Asian+People%22">Asian People*</searchLink>/<searchLink fieldCode="MM" term="%22Asian+People+genetics%22">genetics</searchLink> <br /><searchLink fieldCode="MM" term="%22Mendelian+Randomization+Analysis%22">Mendelian Randomization Analysis*</searchLink><br /><searchLink fieldCode="MH" term="%22Asia%22">Asia</searchLink>/<searchLink fieldCode="MH" term="%22Asia+epidemiology%22">epidemiology</searchLink> ; <searchLink fieldCode="MH" term="%22Smoking%22">Smoking</searchLink>/<searchLink fieldCode="MH" term="%22Smoking+adverse+effects%22">adverse effects</searchLink> ; <searchLink fieldCode="MH" term="%22Smoking%22">Smoking</searchLink>/<searchLink fieldCode="MH" term="%22Smoking+epidemiology%22">epidemiology</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Risk+Factors%22">Risk Factors</searchLink> ; <searchLink fieldCode="MH" term="%22Genome-Wide+Association+Study%22">Genome-Wide Association Study</searchLink> ; <searchLink fieldCode="MH" term="%22Incidence%22">Incidence</searchLink> ; <searchLink fieldCode="MH" term="%22Prevalence%22">Prevalence</searchLink> ; <searchLink fieldCode="MH" term="%22Disability-Adjusted+Life+Years%22">Disability-Adjusted Life Years</searchLink> ; <searchLink fieldCode="MH" term="%22East+Asian+People%22">East Asian People</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: This study aimed to systematically investigate the epidemiological distribution characteristics and disease burden of cervical cancer (CC) in Asian populations, and to assess the causal relationship between smoking, a key modifiable risk factor, and the incidence of CC based on genetic evidence, thereby providing a scientific basis for targeted prevention and control strategies in Asia. This study first used the GBD 2021 database to analyze trends in CC incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021 across global, Asian, and East Asian regions, along with age distribution and attributable risk factors. It then applied 2-sample Mendelian randomization (MR) using genome-wide association study (GWAS) data from East Asian populations, with multiple smoking-related behaviors (e.g., current smoking, cigarettes per day, household smoking exposure) as exposures and CC as the outcome. GBD analysis revealed that in 2021, Asia accounted for over half of the global CC disease burden. Although point estimates suggested a potential upward trend in CC burden across Asia from 1990 to 2021, statistical significance was not reached for the overall Asian population. Despite a general decline in the global incidence rate, the incidence in Japan exhibited a statistically supported upward trend, while point estimates in several other East Asian countries also suggested an increase. The peak disease burden was concentrated among women aged 55 to 59 years. Risk attribution analysis indicated that unsafe sexual behavior was the primary attributable factor for CC-related DALYs, while the attributable burden of smoking was significantly higher in Japan than in other regions. However, MR analysis did not identify statistically significant causal associations between any smoking-related exposure factors and CC risk (P-FDR ≥ .05 after false discovery rate correction). Sensitivity analyses revealed no substantial heterogeneity or pleiotropy bias. Asia, particularly East Asia, faces a substantial and potentially growing burden of CC. Causal inference based on genetic data from East Asian populations did not confirm a direct causal relationship between smoking and the incidence of cervical cancer. Future studies with larger genetic samples are needed to further elucidate the precise role of smoking.<br /> (Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, LLC.)
– Name: Abstract
  Label: Competing Interests
  Group: Ab
  Data: The authors have no funding and conflicts of interest to declare.
– Name: Ref
  Label: References
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  Data: Lancet Public Health. 2023 Dec;8(12):e943-e955. (PMID: <searchLink fieldCode="PM" term="%2238000889%22">38000889)</searchLink><br />J Int Med Res. 2025 Oct;53(10):3000605251383687. (PMID: <searchLink fieldCode="PM" term="%2241062422%22">41062422)</searchLink><br />Korean J Fam Med. 2022 May;43(3):168-173. (PMID: <searchLink fieldCode="PM" term="%2235610963%22">35610963)</searchLink><br />Lancet. 2020 Feb 22;395(10224):575-590. (PMID: <searchLink fieldCode="PM" term="%2232007141%22">32007141)</searchLink><br />Cancer Epidemiol. 2023 Jun;84:102353. (PMID: <searchLink fieldCode="PM" term="%2236989957%22">36989957)</searchLink><br />Cancer Commun (Lond). 2025 Feb;45(2):77-109. (PMID: <searchLink fieldCode="PM" term="%2239611440%22">39611440)</searchLink><br />Am J Med. 1997 May 5;102(5A):3-8. (PMID: <searchLink fieldCode="PM" term="%229217656%22">9217656)</searchLink><br />In Vivo. 2021 Mar-Apr;35(2):1017-1026. (PMID: <searchLink fieldCode="PM" term="%2233622897%22">33622897)</searchLink><br />Public Health Nurs. 2024 Sep-Oct;41(5):1027-1038. (PMID: <searchLink fieldCode="PM" term="%2239054588%22">39054588)</searchLink><br />Biochim Biophys Acta Rev Cancer. 2024 Nov;1879(6):189192. (PMID: <searchLink fieldCode="PM" term="%2239349261%22">39349261)</searchLink><br />J Med Virol. 2025 Feb;97(2):e70238. (PMID: <searchLink fieldCode="PM" term="%2239963849%22">39963849)</searchLink><br />Cancer Res. 2020 Aug 15;80(16):3443-3446. (PMID: <searchLink fieldCode="PM" term="%2232606005%22">32606005)</searchLink><br />Lancet Glob Health. 2023 Feb;11(2):e197-e206. (PMID: <searchLink fieldCode="PM" term="%2236528031%22">36528031)</searchLink><br />Sex Transm Dis. 2014 Nov;41(11):660-4. (PMID: <searchLink fieldCode="PM" term="%2225299412%22">25299412)</searchLink><br />Am J Reprod Immunol. 2024 Sep;92(3):e13922. (PMID: <searchLink fieldCode="PM" term="%2239268635%22">39268635)</searchLink><br />Healthcare (Basel). 2025 Nov 10;13(22):. (PMID: <searchLink fieldCode="PM" term="%2241302241%22">41302241)</searchLink><br />Chin J Cancer Res. 2020 Dec 31;32(6):720-728. (PMID: <searchLink fieldCode="PM" term="%2233446995%22">33446995)</searchLink><br />Chin Med J (Engl). 2021 Jul 14;134(15):1838-1844. (PMID: <searchLink fieldCode="PM" term="%2234267066%22">34267066)</searchLink><br />Lancet Public Health. 2020 Apr;5(4):e223-e234. (PMID: <searchLink fieldCode="PM" term="%2232057317%22">32057317)</searchLink><br />Cancer Biol Med. 2025 Oct 6;22(9):. (PMID: <searchLink fieldCode="PM" term="%2241054968%22">41054968)</searchLink><br />BMJ. 2022 Dec 15;379:e070115. (PMID: <searchLink fieldCode="PM" term="%2236521855%22">36521855)</searchLink><br />Cancer Res Treat. 2024 Jul;56(3):898-908. (PMID: <searchLink fieldCode="PM" term="%2238228083%22">38228083)</searchLink><br />J Virol. 2008 Jan;82(2):1053-8. (PMID: <searchLink fieldCode="PM" term="%2217989183%22">17989183)</searchLink><br />BMJ. 2022 Jul 27;378:e069679. (PMID: <searchLink fieldCode="PM" term="%2235896191%22">35896191)</searchLink><br />Cancer. 2024 Aug 1;130(15):2571-2576. (PMID: <searchLink fieldCode="PM" term="%2238651760%22">38651760)</searchLink><br />Expert Rev Anticancer Ther. 2021 Jul;21(7):781-794. (PMID: <searchLink fieldCode="PM" term="%2233663309%22">33663309)</searchLink><br />JAMA Oncol. 2024 Sep 1;10(9):1237-1244. (PMID: <searchLink fieldCode="PM" term="%2238990578%22">38990578)</searchLink><br />J Matern Fetal Neonatal Med. 2024 Dec;37(1):2294691. (PMID: <searchLink fieldCode="PM" term="%2238146168%22">38146168)</searchLink><br />Nat Rev Cancer. 2021 Oct;21(10):607-608. (PMID: <searchLink fieldCode="PM" term="%2234376828%22">34376828)</searchLink><br />Transl Oncol. 2025 Oct;60:102473. (PMID: <searchLink fieldCode="PM" term="%2240690821%22">40690821)</searchLink>
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