Cancer of the uterine cervix in Aberdeenshire. Aetiological aspects.

Abstract

EPIDEMIOLOGICAL aspects of clinical cancer of the cervix in Aberdeenshire were discussed in the preceding article (Aitken-Swan and Baird, 1966). This paper presents the results of a supplementary study of social and environmental factors thought to be of significance in the aetiology of the disease. Three groups of women were interviewed by one of us (J.A.-S.).Patients with clinical cancer: These were Aberdeenshire patients first attending hospital during the years 1961-63. Through the co-operation of Professor James Walker, numbers were augmented by the inclusion of all patients living in the city of Dundee who first attended a hospital there between 1958-63 and who were available for interview.Patients with pre-clinical cancer: Since April, 1958, gynaecological and obstetrical patients, women attending various clinics or registered with certain general practices in the city have been screened by a cytological team based on the University Department of Obstetrics and Gynaecology. The opportunity was taken to interview the first 143 ever-married women with pre-invasive cancer (sometimes known as carcinoma-in-situ) or microinvasive cancer of the cervix diagnosed by cytology and subsequent histology. Later, 57 women living in country districts were added, bringing the total to 200.A control group without cancer: These were selected from ever-married women taking part in the cytology campaign, matched to the group with pre-clinical cancer for age, number of pregnancies, city or country residence and source of contact with the campaign (post-natal clinic, gynaecological ward, general practice, etc.) Seventy per cent could be matched in all particulars, 27 per cent differed by one year of age only and 3 per cent differed by more than this. The factors considered include age, marital state, coitus, marriage and pregnancies, circumcision and contraception. Some of these factors could be studied in patients who were not interviewed, as a detailed obstetrical history and certaini social data were routinely recorded in the medical case-notes. Interviews were at the woman's home by appointment. Numbers are as follows: Total Interviewed

Cancer of the uterine cervix in Aberdeenshire. Epidemiological aspects.

“…They might be questioned oni the grounds of too elaborate a standardisation procedure for the small numbers involved. It is relevant to note here, however, that a comparison in the second part of this study (Aitken-Swan and Baird, 1966) of age at marriage of patients with pre-clinical cancer of the cervix and controls matched for age and parity shows marriage under age 20 to be equally frequent in both groups.…”

“…2 This is doubtless associated with the fact that as social class declines age at marriage is a less reliable indicator of age at first coitus, as will be seen in the following paper (Aitken-Swan and Baird, 1966) of this article. Similarly, as the bottom diagram shows, women in the high risk group with 3 or 4 children have a higher rate than women in the low risk group with 5 or more.…”

Incidence of cervical cancer by marital status.

“…In Denmark, Grunfeld et al (1975) showed that divorced women had higher death rates from cervical cancer than widows. In Aberdeenshire, Aitken-Swan and Baird (1966) found substantially more divorced women and only slightly more widows in a group with carcinoma in situ than in a matched control group. By contrast, among Jewish women in Israel with cervical cancer, Pridan and Lilienfeld (1971) found substantially more widows as well as more who had been divorced than in a control group.…”

THE NATURAL HISTORY OF CERVICAL CARCINOMA IN SITU

“…Epidemiological studies have revealed many factors related to the incidence of carcinoma in situ (Aitken-Swan and Baird, 1966). Epidemiological studies have revealed many factors related to the incidence of carcinoma in situ (Aitken-Swan and Baird, 1966).…”