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  • Title: Cancer of the cervix: a sexually transmitted infection?
    Author: Beral V.
    Journal: Lancet; 1974 May 25; 1(7865):1037-40. PubMed ID: 4133714.
    Abstract:
    It has been established that sexual activity is a major factor in the genesis of cervical cancer. There are 2 current etiological hypotheses based on these observations. The 1st hypothesis stresses the association of cervical cancer with factors related to an early age at 1st intercourse. The 2nd hypothesis stresses the association of cervical cancer with factors related to the multiplicity of sexual partners, not only of the woman herself, but also of her husband. It proposes that malignant change is induced by a sexually transmitted infection. It is assumed that during a woman's life her risk of exposure to gonorrhea is limited to a relatively short period in early adulthood. It is also assumed that a woman's chance of becoming infected depends on the level of gonorrhea in the community when her risk of infection is greatest, i.e., the incidence of gonorrhea when she is aged 20. When mortality patterns for cancer of the uterine cervix were compared with trends in incidence of sexually transmitted diseases in both England and Wales and in Scotland, there were striking associations between the temporal, social class, occupational, and geographic distributions of these diseases. The data examined were mortality rates from cervical cancer in successive generations of women in England and Wales born between 1902 and 1947 and between 1902 and 1942 for Scotland. The data were taken from the annual reports of the Registrar Generals of England and Wales and of Scotland. Both venereal disease and cervical cancer mortality are more common in urban areas and around seaports than in the country as a whole. Cervical cancer mortality shows a strong social class gradient. Social class is determined by occupation, and for married women by husband's occupation. Wives of professional men experienced mortality rates only 35% as high as the rates for all married women, and wives of unskilled laborers experienced rates 181% of those of all married women. The correlation between mortality from syphilis among males and cervical cancer in their wives was pronounced, both by social class and by occupation. In sum, the data suggest that exposure to sexually transmitted infection is an important determinant of cervical cancer. If cervical cancer prevention and therapy remain unchanged, the high risk of death from cervical cancer of the generation of women born after 1940 will probably continue to operate throughout their lives.
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