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Published in: Archives of Gynecology and Obstetrics 4/2016

01-04-2016 | Gynecologic Oncology

Association between serum folate level and cervical cancer: a meta-analysis

Authors: Xinyue Zhou, Yuanguang Meng

Published in: Archives of Gynecology and Obstetrics | Issue 4/2016

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Abstract

Purpose

The aim of this study was to evaluate the association between serum folate level and cervical cancer.

Methods

PubMed, Medline, Springer, Elsevier Science Direct, Cochrane Library and Google scholar were searched for relevant trials. Rev.Man5.1 and Stata 11.0 software were applied for this meta-analysis. Odds Ratio (OR) and 95 % confidence intervals (95 % CI) were collected and calculated in a fixed-effects model or a random-effects model when appropriate. Subgroup analysis was performed by sample size, participant’s geographical location and definition of deficient serum folate level.

Results

A total of 6 case–control studies including 2383 participants were included in the meta-analysis. The overall meta-analysis showed that there were significant differences between cases and controls, suggesting that deficient serum folate level was associated with the increased risk of cervical cancer. After stratification subgroup analysis, significant difference was also found in subgroup with sample size <500 as well as in Asian population, but not in subgroup with sample size ≥500, American populations as well as different definition of deficient serum folate level (<6.4 ng/ml or others).

Conclusions

Based on our meta-analysis, deficiency of serum folate level was associated with the increased risk of cervical cancer among Asian populations.
Literature
1.
go back to reference Williams MS (2014) A qualitative assessment of the social cultural factors that influence cervical cancer screening behaviors and the health communication preferences of women in Kumasi, Ghana. J Cancer Edu Off J Am Assoc Cancer Edu 29(3):555–562CrossRef Williams MS (2014) A qualitative assessment of the social cultural factors that influence cervical cancer screening behaviors and the health communication preferences of women in Kumasi, Ghana. J Cancer Edu Off J Am Assoc Cancer Edu 29(3):555–562CrossRef
2.
go back to reference Su SY, Huang JY, Ho CC, Liaw YP (2013) Evidence for cervical cancer mortality with screening program in Taiwan, 1981–2010: age-period-cohort model. BMC Public Health 13:13CrossRefPubMedPubMedCentral Su SY, Huang JY, Ho CC, Liaw YP (2013) Evidence for cervical cancer mortality with screening program in Taiwan, 1981–2010: age-period-cohort model. BMC Public Health 13:13CrossRefPubMedPubMedCentral
3.
go back to reference Sankaranarayanan R, Esmy PO, Rajkumar R, Muwonge R, Swaminathan R, Shanthakumari S, Fayette JM, Cherian J (2007) Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial. Lancet 370(9585):398–406CrossRefPubMed Sankaranarayanan R, Esmy PO, Rajkumar R, Muwonge R, Swaminathan R, Shanthakumari S, Fayette JM, Cherian J (2007) Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial. Lancet 370(9585):398–406CrossRefPubMed
4.
go back to reference Odongua N, Chae YM, Kim MR, Yun JE, Jee SH (2007) Associations between smoking, screening, and death caused by cervical cancer in Korean women. Yonsei Med J 48(2):192–200CrossRefPubMedPubMedCentral Odongua N, Chae YM, Kim MR, Yun JE, Jee SH (2007) Associations between smoking, screening, and death caused by cervical cancer in Korean women. Yonsei Med J 48(2):192–200CrossRefPubMedPubMedCentral
5.
go back to reference Murillo R, Almonte M, Pereira A, Ferrer E, Gamboa OA, Jeronimo J, Lazcano-Ponce E (2008) Cervical cancer screening programs in Latin America and the Caribbean. Vaccine 26(Suppl 11):L37–L48CrossRefPubMed Murillo R, Almonte M, Pereira A, Ferrer E, Gamboa OA, Jeronimo J, Lazcano-Ponce E (2008) Cervical cancer screening programs in Latin America and the Caribbean. Vaccine 26(Suppl 11):L37–L48CrossRefPubMed
6.
go back to reference Herrero R, Ferreccio C, Salmeron J, Almonte M, Sanchez GI, Lazcano-Ponce E, Jeronimo J (2008) New approaches to cervical cancer screening in Latin America and the Caribbean. Vaccine 26(Suppl 11):L49–L58CrossRefPubMed Herrero R, Ferreccio C, Salmeron J, Almonte M, Sanchez GI, Lazcano-Ponce E, Jeronimo J (2008) New approaches to cervical cancer screening in Latin America and the Caribbean. Vaccine 26(Suppl 11):L49–L58CrossRefPubMed
7.
go back to reference Choconta-Piraquive LA, Alvis-Guzman N, De la Hoz-Restrepo F (2010) How protective is cervical cancer screening against cervical cancer mortality in developing countries? The Colombian case. BMC Health Serv Res 10:270CrossRefPubMedPubMedCentral Choconta-Piraquive LA, Alvis-Guzman N, De la Hoz-Restrepo F (2010) How protective is cervical cancer screening against cervical cancer mortality in developing countries? The Colombian case. BMC Health Serv Res 10:270CrossRefPubMedPubMedCentral
8.
go back to reference Wang H, Xu H, Lu W, Zhu L, Yu Y, Hong F (2014) In vitro and in vivo evaluations of human papillomavirus type 16 (HPV16)-derived peptide-loaded dendritic cells (DCs) with a CpG oligodeoxynucleotide (CpG-ODN) adjuvant as tumor vaccines for immunotherapy of cervical cancer. Arch Gynecol Obstet 289(1):155–162CrossRefPubMed Wang H, Xu H, Lu W, Zhu L, Yu Y, Hong F (2014) In vitro and in vivo evaluations of human papillomavirus type 16 (HPV16)-derived peptide-loaded dendritic cells (DCs) with a CpG oligodeoxynucleotide (CpG-ODN) adjuvant as tumor vaccines for immunotherapy of cervical cancer. Arch Gynecol Obstet 289(1):155–162CrossRefPubMed
9.
go back to reference Liu Z, Shi Y, Meng W, Liu Y, Yang K, Wu S, Peng Z (2014) Expression and localization of maspin in cervical cancer and its role in tumor progression and lymphangiogenesis. Arch Gynecol Obstet 289(2):373–382CrossRefPubMedPubMedCentral Liu Z, Shi Y, Meng W, Liu Y, Yang K, Wu S, Peng Z (2014) Expression and localization of maspin in cervical cancer and its role in tumor progression and lymphangiogenesis. Arch Gynecol Obstet 289(2):373–382CrossRefPubMedPubMedCentral
10.
go back to reference Miller AB, Organization WH (1992) Cervical cancer screening programmes: managerial guidelines/AB Miller Miller AB, Organization WH (1992) Cervical cancer screening programmes: managerial guidelines/AB Miller
11.
go back to reference Cancer IAfRo, Humans IWGotEoCRt (2001) IARC monographs on the evaluation of carcinogenic risks to humans, vol 78. International Agency for Research on Cancer Cancer IAfRo, Humans IWGotEoCRt (2001) IARC monographs on the evaluation of carcinogenic risks to humans, vol 78. International Agency for Research on Cancer
12.
go back to reference Tong SY, Kim MK, Lee JK, Lee JM, Choi SW, Friso S, Song ES, Lee KB, Lee JP (2011) Common polymorphisms in methylenetetrahydrofolate reductase gene are associated with risks of cervical intraepithelial neoplasia and cervical cancer in women with low serum folate and vitamin B12. Cancer Causes Control CCC 22(1):63–72CrossRefPubMed Tong SY, Kim MK, Lee JK, Lee JM, Choi SW, Friso S, Song ES, Lee KB, Lee JP (2011) Common polymorphisms in methylenetetrahydrofolate reductase gene are associated with risks of cervical intraepithelial neoplasia and cervical cancer in women with low serum folate and vitamin B12. Cancer Causes Control CCC 22(1):63–72CrossRefPubMed
13.
go back to reference Piyathilake CJ, Badiga S, Paul P, Vijayaraghavan K, Vedantham H, Sudula M, Sowjanya P, Ramakrishna G, Shah KV, Partridge EE, Gravitt PE (2010) Indian women with higher serum concentrations of folate and vitamin B12 are significantly less likely to be infected with carcinogenic or high-risk (HR) types of human papillomaviruses (HPVs). Int J Womens Health 2:7–12CrossRefPubMedPubMedCentral Piyathilake CJ, Badiga S, Paul P, Vijayaraghavan K, Vedantham H, Sudula M, Sowjanya P, Ramakrishna G, Shah KV, Partridge EE, Gravitt PE (2010) Indian women with higher serum concentrations of folate and vitamin B12 are significantly less likely to be infected with carcinogenic or high-risk (HR) types of human papillomaviruses (HPVs). Int J Womens Health 2:7–12CrossRefPubMedPubMedCentral
14.
go back to reference Duthie SJ (1999) Folic acid deficiency and cancer: mechanisms of DNA instability. Br Med Bull 55(3):578–592CrossRefPubMed Duthie SJ (1999) Folic acid deficiency and cancer: mechanisms of DNA instability. Br Med Bull 55(3):578–592CrossRefPubMed
15.
16.
go back to reference Eto I, Krumdieck CL (1986) Role of vitamin B12 and folate deficiencies in carcinogenesis. Adv Exp Med Biol 206:313–330PubMed Eto I, Krumdieck CL (1986) Role of vitamin B12 and folate deficiencies in carcinogenesis. Adv Exp Med Biol 206:313–330PubMed
17.
go back to reference Mason JB, Levesque T (1996) Folate: effects on carcinogenesis and the potential for cancer chemoprevention. Oncol 10(11):1727–1743 Mason JB, Levesque T (1996) Folate: effects on carcinogenesis and the potential for cancer chemoprevention. Oncol 10(11):1727–1743
18.
go back to reference Kim YI (1999) Folate and carcinogenesis: evidence, mechanisms, and implications. J Nutr Biochem 10(2):66–88CrossRefPubMed Kim YI (1999) Folate and carcinogenesis: evidence, mechanisms, and implications. J Nutr Biochem 10(2):66–88CrossRefPubMed
19.
go back to reference Tomita LY, D’Almeida V, Villa LL, Franco EL, Cardoso MA (2013) Polymorphisms in genes involved in folate metabolism modify the association of dietary and circulating folate and vitamin B-6 with cervical neoplasia. J Nutr 143(12):2007–2014CrossRefPubMed Tomita LY, D’Almeida V, Villa LL, Franco EL, Cardoso MA (2013) Polymorphisms in genes involved in folate metabolism modify the association of dietary and circulating folate and vitamin B-6 with cervical neoplasia. J Nutr 143(12):2007–2014CrossRefPubMed
20.
go back to reference Ragasudha PN, Thulaseedharan JV, Wesley R, Jayaprakash PG, Lalitha P, Pillai MR (2012) A case-control nutrigenomic study on the synergistic activity of folate and vitamin B12 in cervical cancer progression. Nutr Cancer 64(4):550–558CrossRefPubMed Ragasudha PN, Thulaseedharan JV, Wesley R, Jayaprakash PG, Lalitha P, Pillai MR (2012) A case-control nutrigenomic study on the synergistic activity of folate and vitamin B12 in cervical cancer progression. Nutr Cancer 64(4):550–558CrossRefPubMed
21.
go back to reference VanEenwyk J, Davis FG, Colman N (1992) Folate, vitamin C, and cervical intraepithelial neoplasia. Cancer Epidemiol Biomark Prev 1(2):119–124 VanEenwyk J, Davis FG, Colman N (1992) Folate, vitamin C, and cervical intraepithelial neoplasia. Cancer Epidemiol Biomark Prev 1(2):119–124
22.
go back to reference Weinstein SJ, Ziegler RG, Frongillo EA Jr, Colman N, Sauberlich HE, Brinton LA, Hamman RF, Levine RS, Mallin K, Stolley PD, Bisogni CA (2001) Low serum and red blood cell folate are moderately, but nonsignificantly associated with increased risk of invasive cervical cancer in U.S. women. J Nutr 131(7):2040–2048PubMed Weinstein SJ, Ziegler RG, Frongillo EA Jr, Colman N, Sauberlich HE, Brinton LA, Hamman RF, Levine RS, Mallin K, Stolley PD, Bisogni CA (2001) Low serum and red blood cell folate are moderately, but nonsignificantly associated with increased risk of invasive cervical cancer in U.S. women. J Nutr 131(7):2040–2048PubMed
23.
go back to reference Deeks JJ, Altman DG, Bradburn MJ (2001) Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Smith GD, Altman DG (eds) Systematic reviews in health care: meta-analysis in context, 2nd edn. BMJ publishing group, London, pp 285–312 Deeks JJ, Altman DG, Bradburn MJ (2001) Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Smith GD, Altman DG (eds) Systematic reviews in health care: meta-analysis in context, 2nd edn. BMJ publishing group, London, pp 285–312
24.
go back to reference Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Int Med 127(9):820–826CrossRefPubMed Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Int Med 127(9):820–826CrossRefPubMed
26.
27.
go back to reference Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease
29.
go back to reference Liu ZH, Ding YL, Xiu LC, Pan HY, Liang Y, Zhong SQ, Liu WW, Rao SQ, Kong DL (2013) A meta-analysis of the association between TNF-alpha -308G > A polymorphism and type 2 diabetes mellitus in Han Chinese population. PLoS One 8(3):e59421CrossRefPubMedPubMedCentral Liu ZH, Ding YL, Xiu LC, Pan HY, Liang Y, Zhong SQ, Liu WW, Rao SQ, Kong DL (2013) A meta-analysis of the association between TNF-alpha -308G > A polymorphism and type 2 diabetes mellitus in Han Chinese population. PLoS One 8(3):e59421CrossRefPubMedPubMedCentral
30.
go back to reference Kwanbunjan K, Saengkar P, Cheeramakara C, Thanomsak W, Benjachai W, Laisupasin P, Buchachart K, Songmuaeng K, Boontaveeyuwat N (2005) Low folate status as a risk factor for cervical dysplasia in Thai women. Nutr Res 25(7):641–654CrossRef Kwanbunjan K, Saengkar P, Cheeramakara C, Thanomsak W, Benjachai W, Laisupasin P, Buchachart K, Songmuaeng K, Boontaveeyuwat N (2005) Low folate status as a risk factor for cervical dysplasia in Thai women. Nutr Res 25(7):641–654CrossRef
31.
go back to reference Potischman N, Brinton LA, Laiming VA, Reeves WC, Brenes MM, Herrero R, Tenorio F, de Britton RC, Gaitan E (1991) A case-control study of serum folate levels and invasive cervical cancer. Cancer Res 51(18):4785–4789PubMed Potischman N, Brinton LA, Laiming VA, Reeves WC, Brenes MM, Herrero R, Tenorio F, de Britton RC, Gaitan E (1991) A case-control study of serum folate levels and invasive cervical cancer. Cancer Res 51(18):4785–4789PubMed
32.
go back to reference Wang JT, Ma XC, Cheng YY, Ding L, Zhou Q (2006) A case-control study on the association between folate and cervical cancer. Chin J Epidemiol 27(5):424–427 Wang JT, Ma XC, Cheng YY, Ding L, Zhou Q (2006) A case-control study on the association between folate and cervical cancer. Chin J Epidemiol 27(5):424–427
33.
go back to reference Powers HJ (2005) Interaction among folate, riboflavin, genotype, and cancer, with reference to colorectal and cervical cancer. J Nutr 135(12):2960S–2966SPubMed Powers HJ (2005) Interaction among folate, riboflavin, genotype, and cancer, with reference to colorectal and cervical cancer. J Nutr 135(12):2960S–2966SPubMed
34.
go back to reference Bai L-X, Wang J-T, Ding L, Jiang S-W, Kang H-J, Gao C-F, Chen X, Chen C, Zhou Q (2014) Folate deficiency and FHIT hypermethylation and HPV 16 infection promote cervical cancerization. Asian Pac J Cancer Prev APJCP 15(21):9313CrossRefPubMed Bai L-X, Wang J-T, Ding L, Jiang S-W, Kang H-J, Gao C-F, Chen X, Chen C, Zhou Q (2014) Folate deficiency and FHIT hypermethylation and HPV 16 infection promote cervical cancerization. Asian Pac J Cancer Prev APJCP 15(21):9313CrossRefPubMed
35.
go back to reference Jin-tao W, Ling D, Shi-Wen J, Junxia H, Wei-min Z, Qin Z, Zuo-kai Y, Li Z (2014) Folate deficiency and aberrant expression of DNA methyltransferase 1 were associated with cervical cancerization. Curr Pharm Des 20(11):1639–1646CrossRef Jin-tao W, Ling D, Shi-Wen J, Junxia H, Wei-min Z, Qin Z, Zuo-kai Y, Li Z (2014) Folate deficiency and aberrant expression of DNA methyltransferase 1 were associated with cervical cancerization. Curr Pharm Des 20(11):1639–1646CrossRef
36.
go back to reference S-y Tong, Kim MK, Lee JK, Lee JM, Choi SW, Friso S, Song E-S, Lee KB, Lee JP (2011) Common polymorphisms in methylenetetrahydrofolate reductase gene are associated with risks of cervical intraepithelial neoplasia and cervical cancer in women with low serum folate and vitamin B12. Cancer Causes Control 22(1):63–72CrossRef S-y Tong, Kim MK, Lee JK, Lee JM, Choi SW, Friso S, Song E-S, Lee KB, Lee JP (2011) Common polymorphisms in methylenetetrahydrofolate reductase gene are associated with risks of cervical intraepithelial neoplasia and cervical cancer in women with low serum folate and vitamin B12. Cancer Causes Control 22(1):63–72CrossRef
37.
go back to reference Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MCB, Su J, Xu F, Weinstock H (2013) Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis 40(3):187–193CrossRefPubMed Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MCB, Su J, Xu F, Weinstock H (2013) Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis 40(3):187–193CrossRefPubMed
38.
go back to reference Schlecht NF, Kulaga S, Robitaille J, Ferreira S, Santos M, Miyamura RA, Duarte-Franco E, Rohan TE, Ferenczy A, Villa LL (2001) Persistent human papillomavirus infection as a predictor of cervical intraepithelial neoplasia. JAMA 286(24):3106–3114CrossRefPubMed Schlecht NF, Kulaga S, Robitaille J, Ferreira S, Santos M, Miyamura RA, Duarte-Franco E, Rohan TE, Ferenczy A, Villa LL (2001) Persistent human papillomavirus infection as a predictor of cervical intraepithelial neoplasia. JAMA 286(24):3106–3114CrossRefPubMed
39.
go back to reference Pillai M, Chacko P, Kesari L, Jayaprakash P, Jayaram H, Antony A (2003) Expression of folate receptors and heterogeneous nuclear ribonucleoprotein E1 in women with human papillomavirus mediated transformation of cervical tissue to cancer. J Clin Pathol 56(8):569–574CrossRefPubMedPubMedCentral Pillai M, Chacko P, Kesari L, Jayaprakash P, Jayaram H, Antony A (2003) Expression of folate receptors and heterogeneous nuclear ribonucleoprotein E1 in women with human papillomavirus mediated transformation of cervical tissue to cancer. J Clin Pathol 56(8):569–574CrossRefPubMedPubMedCentral
40.
go back to reference Piyathilake CJ, Henao OL, Macaluso M, Cornwell PE, Meleth S, Heimburger DC, Partridge EE (2004) Folate is associated with the natural history of high-risk human papillomaviruses. Cancer Res 64(23):8788–8793CrossRefPubMed Piyathilake CJ, Henao OL, Macaluso M, Cornwell PE, Meleth S, Heimburger DC, Partridge EE (2004) Folate is associated with the natural history of high-risk human papillomaviruses. Cancer Res 64(23):8788–8793CrossRefPubMed
41.
go back to reference Saavedra KP, Brebi PM, Roa JC (2012) Epigenetic alterations in preneoplastic and neoplastic lesions of the cervix. Clin Epigenet 4(1):13CrossRef Saavedra KP, Brebi PM, Roa JC (2012) Epigenetic alterations in preneoplastic and neoplastic lesions of the cervix. Clin Epigenet 4(1):13CrossRef
42.
go back to reference Wagner C (1995) Biochemical role of folate in cellular metabolism. Folate Health Dis 1:23–42 Wagner C (1995) Biochemical role of folate in cellular metabolism. Folate Health Dis 1:23–42
43.
go back to reference Costello JF, Frühwald MC, Smiraglia DJ, Rush LJ, Robertson GP, Gao X, Wright FA, Feramisco JD, Peltomäki P, Lang JC (2000) Aberrant CpG-island methylation has non-random and tumour-type–specific patterns. Nat Genet 24(2):132–138CrossRefPubMed Costello JF, Frühwald MC, Smiraglia DJ, Rush LJ, Robertson GP, Gao X, Wright FA, Feramisco JD, Peltomäki P, Lang JC (2000) Aberrant CpG-island methylation has non-random and tumour-type–specific patterns. Nat Genet 24(2):132–138CrossRefPubMed
45.
go back to reference Fang J, Zhang H, Jin S (2014) Epigenetics and cervical cancer: from pathogenesis to therapy. Tumour Biol J Int Soc Oncodevelopment Biol Med 35(6):5083–5093CrossRef Fang J, Zhang H, Jin S (2014) Epigenetics and cervical cancer: from pathogenesis to therapy. Tumour Biol J Int Soc Oncodevelopment Biol Med 35(6):5083–5093CrossRef
Metadata
Title
Association between serum folate level and cervical cancer: a meta-analysis
Authors
Xinyue Zhou
Yuanguang Meng
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 4/2016
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-015-3852-5

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