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Is the risk of cervical atypia associated with the interval between menarche and the start of sexual activity? A population-based cohort study
  1. Indira Adhikari1,
  2. Tiina Eriksson1,
  3. Tapio Luostarinen2,
  4. Dan Apter3,
  5. Matti Lehtinen1
  1. 1Department of Health Sciences, Tampere University, Tampere, Finland
  2. 2Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
  3. 3VL-Medi, Helsinki, Finland
  1. Correspondence to Indira Adhikari; indira.adhikari{at}


Objective We investigated whether the risk of cervical atypia is associated with a short interval between the age at first sexual intercourse (FSI) or age at the start of oral contraceptive (OC) use and menarche.

Design A population-based cohort study.

Setting Finnish women in the age range of 16–17 years old were enrolled in the PATRICIA trial of human papillomavirus (HPV) 16/18 vaccine efficacy.

Participants The association of cervical atypia with the interval between FSI or start of OC use and menarche was assessed in the control arm (hepatitis A vaccinated) who had participated in biannual clinical follow-up visits for 4 years. Altogether, 913 women had normal baseline cervical cytology and answered behavioural questionnaires at enrolment and end of the follow-up.

Main outcome measure ORs with 95% CIs using univariate and multivariable logistic regression were used to assess the association between cervical atypia and the interval between FSI or the start of OC use and menarche.

Results The mean ages at menarche, FSI and the start of OC use were 12.4, 16.0 and 16.4. Chlamydiatrachomatis infection was associated with an increased risk of cervical atypia in women with a short (<3 years) interval between menarche and FSI/start of OC use (OR 1.8, 95% CI 1.0 to 3.6 and OR 2.2, 95% CI 1.0 to 5.1). Whereas HPV 16/18 infection was associated with increased atypia risk estimates in women with a longer (≥3 years) interval (OR 1.8, 95% CI 1.1 to 2.7 and OR 1.4, 95% CI 1.0 to 2.1). In women with a short interval between menarche and FSI, early age at the start of OC use was not associated with an increased risk of cervical atypia in the univariate (OR 0.7) nor multivariable analyses.

Conclusion Short interval between menarche and the age at start of sexual activity does not increase the risk of HPV-associated cervical atypia.

Trial registration number NCT00122681.

  • cervical neoplasia
  • Chlamydia trachomatis
  • first sexual intercourse
  • human papillomavirus
  • menarche
  • oral contraceptives

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  • Contributors IA developed the research protocol, analysed the data and prepared the manuscript. TE contributed in data acquisition and data interpretation. TL contributed in the analysis plan, commented on the drafts of the paper and helped in the revision of paper. DA commented on the tables and drafts of the paper. ML helped in data acquisition, contributed in the development of research plan, analysis plan, commented on the draft of the paper and the revision of the paper.

  • Funding Academy of Finland.

  • Competing interests ML and DA have grants from Merck & Co. Inc. and GSK for HPV vaccination trials through their employers (Tampere University, ML; Family Federation Finland, DA).

  • Patient consent for publication Not required.

  • Ethics approval Finnish national ethics committee (TUKIJA 1174/04).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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