Association between Serum Folate Status and Cervical Intraepithelial Neoplasia

Cervical intraepithelial neoplasia (CIN) is a premalignant lesion of cervix and if left untreated can progress to invasive cervical cancer after several years. Approximately 1.0-2.0% women have CIN II⁺ each year. Folate and vit B12 play important roles as inhibitors of human carcinogenesis in several organs. This study was done to evaluate the association of serum folate level with cervical intraepithelial neoplasia. This was a case control study conducted at colposcopy clinic of Bangladesh Medical University, Bangladesh. One hundred and twenty-two women were included in the study by purposive sampling from October 2019 to September 2020 after getting institutional review board approval. Study population were VIA positive women who were referred for colposcopy at colposcopy clinic of Bangladesh Medical University (BMU), Dhaka, Bangladesh. After getting informed consent, colposcopy and histopathological examination was done in all subjects irrespective of colposcopy result. Cases (n=61) were assigned to those who had histopathologicaly confirmed CIN. Control groups (n=61) were those who had both colposcopicaly and histopathologicaly normal cervix. Both groups were matched in relation to age, age at marriage, age at first delivery, parity and duration of OCP use. Serum folate level was measured in both cases and controls. Data were analyzed using SPSS software version 22. Continuous variables were expressed by mean±SD. Qualitative variables by percentage. Association of folate status and cervical intraepithelial neoplasia were assessed by unpaired 't' test, ANOVA test, Chi-Square test and in odds ratio with 95% CI. Cut off value for low serum folate level was obtained from ROC curve and it was <7.65 ng/ml. Among 61 cases of CIN, 55.0% were CIN I (n=34), 13.0% were CIN II (n=8) and 31.0% (n=19) were CIN III and carcinoma in situ. Statistically significant difference was found (p<0.05) in mean serum folate level between two groups. Among cases it was 9.74±3.51ng/ml and among controls 12.09±5.05 ng/ml, p=0.003s. Using multivariate logistic regression model serum folate <7.65ng/ml was found independently associated with CIN (OR 1.671 95% CI 1.16-2.40, p=0.039s). Low serum folate level was significantly associated with cervical intraepithelial neoplasia. So oral supplementation of folic acid to young adolescent girls and women of reproductive age may be considered to reduce the risk of developing CIN and subsequently cervical cancer.