Cervical Cancer

Abstract

To the Editor:\p=m-\Iwish to take definite exception to a statement made by J. P. Greenhill, M.D., in his answer to a question relating to cancer of the cervix in The Journal (178:1202 [Dec. 30] 1961. He states that cancer of the cervix "usually occurs in women who are past the reproductive period." This statement is completely at variance with the facts, as anyone should know who has had much to do with this disease.Of the first 58 cervical cancers proved in a recently completed 5-year project in Detroit, over one-half were in years of active reproductive life, that is, before age 40. Three-quarters of them were still premenopausal. Nor were these cases all early preinvasive cases, since 15 of them\p=m-\about25%\p=m-\ were invasive. Among the 15 invasive cases, 3 patients were less than 30 years old. Two years ago a patient aged 23 years died in Detroit Receiving Hospital with advanced cervical cancer. Among our more than 500 proved cases in the project, I am sure that analysis of the figures will show results essentially similar to those of the first 58 cases. The literature of the past 10 years abounds in statistics pointing to such facts. be less vehement if I defined "reproductive period" and "cancer." The reproductive period is that period during which women usually have babies. This is not synonymous with the period of menstruation. Many women menstruate past 50 years of age but extremely few become pregnant in these years. In 65,000 deliveries at the Johns Hopkins Hospital there was only one woman over 47 years of age, and at the Chicago Lying-in Hospital, in over 50,000 deliveries, there were only 2 women of 46 and 2 of 48 years of age. By the word "cancer" I mean "invasive cancer." Articles dealing with radical hysterectomy and radiation therapy for malignancy simply use the term "cancer" or "carcinoma of the cervix." In all instances where cancer in situ is discussed, the entire term is used and not simply the word "cancer." If we contrast the 2 types of cancer we use the full terms.Does cancer of the cervix really usually occur after the reproductive period? Stern (Cancer 12:933, 1959) found that the highest rates for cancer in situ occurred between 30 and 49 years and those for invasive cancer in women 50 years or older. Younge 1957) observed that the average age of women with carcinoma in situ is about 38 and of those with invasive cancer nearly 50. Wheeler and Hertig (Amer ] Clin Path 25:345, 1955) found 201 cases of carcinoma in situ at an average age of 38 years and 1,314 cases of invasive carcinoma at an average age of 50.8 years.If I had stated that carcinoma in situ or prein¬ vasive cancer "usually occurs in women who are past the reproductive period" I would indeed have "set the diagnosis of cervical cancer back 10 years."