*Corresponding Author: Dr. Minakshi Vashist, Professor, Department of Genetics, Maharshi Dayanand University, Rohtak, Haryana, India. Email: mvashist14@mdurohtak.ac.in
Background: Cervical cancer remains a major public health concern in low- and middle-income countries, particularly in India, where disparities in screening, education, and preventive services persist. Although persistent infection with high-risk human papillomavirus (HPV) is the primary etiological factor, the contribution of sociodemographic, reproductive, and lifestyle determinants to disease risk requires further elucidation in region-specific contexts.
Methods: A hospital-based, age-matched case–control study was conducted among 464 women, including 232 histopathologically confirmed cervical cancer cases and 232 healthy women as the control group. Data on sociodemographic characteristics, reproductive history, lifestyle factors, and clinical symptoms were collected using a structured questionnaire. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of cervical cancer. Due to quasi-complete separation, the association of HPV infection was assessed using Firth's penalised logistic regression. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis.
Results: The highest proportion of cervical cancer cases was observed in the 51-60 year age group (36.2%). Compared with the control group, cases had significantly higher parity (4.74 ± 1.36 vs. 2.96 ± 1.21; p < 0.001), lower educational attainment (p < 0.001), higher prevalence of smoking (11.6% vs. 3.0%; p < 0.001), and greater use of hormonal contraceptives (12.1% vs. 2.6%; p < 0.001). HPV positivity was markedly higher among cases (91.8%) than the control group (1.3%; p < 0.001). In multivariable analysis, higher parity (adjusted odds ratio [AOR] = 1.88; 95% CI: 1.54–2.29), smoking (AOR = 3.98; 95% CI: 1.67–9.48), hormonal contraceptive use (AOR = 3.42; 95% CI: 1.42–8.21), and low educational status (AOR = 4.61; 95% CI: 3.05–6.97) were independently associated with increased odds of cervical cancer, whereas urban residence was protective (AOR = 0.28; 95% CI: 0.19–0.41). The final model demonstrated excellent discrimination, with an AUC of 0.994.
Conclusion: Cervical cancer risk among Indian women is strongly influenced by reproductive, behavioural, and socioeconomic factors, particularly high parity, smoking, hormonal contraceptive use, and low educational status. These findings underscore the need for targeted prevention strategies focusing on education, tobacco cessation, and reproductive health awareness, alongside strengthened screening and HPV vaccination programs to reduce the disease burden.
Keywords: Cervical cancer, exogenous risk factors, parity, smoking, contraceptive.
How to cite this article: Siwach K, Vashist M, Chauhan M, Kaushik R, Rohilla G, Narwal S. Unmasking the etiological complexity of cervical carcinogenesis: multifactorial case-control analysis. Int J Drug Deliv Technol. 2026;16(6s): 1-9; DOI: 10.25258/ijddt.16.6s.1
Source of support: Nil.
Conflict of interest: None