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March 17, 1989, Vol 261, No. 11 >
ARTICLE | March 17, 1989

Smoking and Cervical Cancer: Cause or Coincidence? FREE

Peter M. Layde, MD, MSc
JAMA. 1989;261(11):1631-1633. doi:10.1001/jama.1989.03420110107032
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References

In the debate on the role of cigarette smoking in the etiology of cervical cancer, there is one central point of agreement: women who smoke cigarettes are more likely to develop cervical neoplasia than are nonsmokers. Beyond that key point, however, there is considerable controversy. The basic question is whether the association of smoking and cervical cancer is causal, mediated by some biologically plausible mechanism, or artifactual, produced by some extraneous confounding difference between smokers and nonsmokers. The noteworthy article by Slattery and collegues1 in this issue of The Journal will open a new controversy in this area by suggesting an etiologic role of passive exposure to the smoke of others' cigarettes in cervical carcinogenesis. In addition, Slattery and colleagues have reopened the long-standing, more general debate about whether cervical cancer should be added to the list of tobacco-induced cancers.

Winkelstein's2 insightful recognition of the similarity of cervical

REFERENCES

1 +
Slattery ML, Robison LM, Schuman KL, et al.  Cigarette smoking and exposure to passive smoke are risk factors for cervical cancer . JAMA. 1989;;261:1593-1598.
2 +
Winkelstein W.  Smoking and cancer of the uterine cervix: hypothesis . Am J Epidemiol. 1977;;106:257-259.
3 +
Wright NH, Vessey MP, Kenward B, McPherson K, Doll R.  Neoplasia and dysplasia of the cervix uteri and contraception: a possible protective effect of the diaphragm . Br J Cancer. 1978;;38:273-279.
4 +
Naguib SM, Lundin FE, Davis HJ.  Relation of various epidemiologic factors to cervical cancer as determined by a screening program . Obstet Gynecol. 1966;;28:451-459.
5 +
Thomas DB.  An epidemiologic study of carcinoma in situ and squamous dysplasia of the uterine cervix . Am J Epidemiol. 1973;;98:10-28.
6 +
Trevathan E, Layde P, Webster LA, Adams JB, Benigno BB, Ory H.  Cigarette smoking and dysplasia and carcinoma in situ of the uterine cervix . JAMA. 1983;;250:499-502.
7 +
Clarke EA, Hatcher J, McKrown-Eyssen GE, Lickrish GM.  Cervical dysplasia: association with sexual behavior, smoking and oral contraceptive use? Am J Obstet Gynecol. 1985;;151:612-616.
8 +
Harris RWC, Brinton LA, Cowdell RH, et al.  Characteristics of women with dysplasia or carcinoma in situ of the cervix uteri . Br J Cancer. 1980;;42:359-369.
9 +
Wigle DT, Mao Y, Grace M.  Re: 'Smoking and cancer of the uterine cervix: hypothesis.' Am J Epidemiol. 1980;;111:125-127.
10 +
Cederlof R, Friberg L, Hrubec Z, Lorich U. The Relationship of Smoking and Some Social Covariables to Mortality and Cancer Morbidity . Stockholm, Sweden: Karolinska Institute; 1975;:1-91.
11 +
Clarke EA, Morgan RW, Newman AM.  Smoking as a risk factor in cancer of the cervix: additional evidence from a case-control study . Am J Epidemiol. 1982;;115:59-66.
12 +
Kessler II, Kulcar Z, Zimolo A, Grgurevich M, Strnad M, Goodwin BJ.  Cervical cancer in Yugoslavia, II: epidemiologic factors of possible etiologic significance . JNCI. 1974;;53:51-60.
13 +
Williams RR, Horm JW.  Association of cancer sites with tobacco and alcohol consumption and socioeconomic status: interview study from the Third National Cancer Survey . JNCI. 1977;;58:525-547.
14 +
Nischan P, Ebling K, Schindler C.  Smoking and invasive cervical cancer risk: results from a case-control study . Am J Epidemiol , 1988;;128:74-77.
15 +
Celentano DD, Klassen AC, Weisman CS, Rosenshein NB.  The role of contraceptive use in cervical cancer: The Maryland Cervical Cancer Case-Control Study . Am J Epidemiol. 1987;;126:592-604.
16 +
Hirayama T.  Prospective studies on cancer epidemiology based on census population in Japan . In: Bucalossi P, Veronesi U, Cascinelli N, eds. Cancer Epidemiology, Environmental Factors . Amsterdam, the Netherlands: Excerpta Medica; 1975;;3:26-35.
17 +
La Vecchia C, Pranceschi S, Decarli A, Fasoli M, Gentile A, Tognomi G.  Cigarette smoking and the risk of cervical neoplasia . Am J Epidemiol. 1986;;123:22-29.
18 +
Buckley JD, Harris RWC, Doll R, Vessey MP.  Case-control study of the husbands of women with dysplasia or carcinoma of the cervix uteri . Lancet. 1981;;2:1010-1015.
19 +
Hill AB.  The environment and disease: association or causation? Proc R Soc Med. 1965;;58:295-300.
20 +
Mayberry RM.  Cigarette smoking, herpes simplex virus type 2 infection, and cervical abnormalities . Am J Public Health. 1985;;75:676-678.
21 +
Sasson IM, Haley NJ, Hoffmann D, Wynder EL, Hellberg D, Nilsson S.  Cigarette smoking and neoplasia of the uterine cervix: smoke constituents in cervical mucus . N Engl J Med. 1985;;312:315-316.
22 +
Hellberg D, Nilsson S, Haley NJ, Hoffmann D, Wynder E.  Smoking and cervical intraepithelial neoplasia: nicotine and cotinine in serum and cervical mucus in smokers and nonsmokers . Am J Obstet Gynecol. 1988;;158:910-913.
23 +
Schiffman M, Brinton L, Holly E, et al.  Regarding mutagenic mucus in the cervix of smokers . JNCI. 1987;;78:590-591.
24 +
Reducing the Health Consequences of Smoking: 25 Years of Progress, a Report of the Surgeon General . Rockville, Md: Office on Smoking and Health; 1989;.
25 +
Tobacco Smoking . Lyons, France, International Agency for Research on Cancer; 1985;;38:282-292. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans.
26 +
Cramer DW.  Uterine cervix . In: Schottenfeld D, Fraumeni JF, eds. Cancer Epidemiology and Prevention . Philadelphia, Pa: WB Saunders Co; 1982;:881-900.
27 +
Josey WE, Nahmias AJ, Naib ZM.  Viruses and cancer of the lower genital tract . Cancer. 1976;;38:526-533.
28 +
Grubb GS.  Human papillomavirus and cervical neoplasia: epidemiological considerations . Int J Epidemiol. 1986;;15:1-7.
29 +
Tokahuta GK.  Tobacco and cancer of the genitalia among married women . Am J Public Health. 1967;;57:830-839.
30 +
Greenland S.  The effect of misclassification in the presence of covariates . Am J Epidemiol. 1980;;112:564-569.
31 +
Kelsey JL, Thompson WD, Evans AS. Methods in Observational Epidemiology . New York, NY: Oxford University Press Inc; 1986;:297-300.
32 +
Schlesselman JJ. Case Control Studies: Design, Conduct and Analysis . New York, NY: Oxford University Press Inc; 1982;.
33 +
Zunzunegui MV, King MC, Coria CF, Charlet J.  Male influences on cervical cancer risk . Am J Epidemiol. 1986;;123:302-307.
34 +
Hellberg D, Valentin J, Nilsson S.  Smoking and cervical intraepithelial neoplasia . Acta Obstet Gynecol Scand. 1986;;65:625-631.
35 +
The Health Consequences of Smoking for Women, a Report of the Surgeon General . Rockville, Md: Office on Smoking and Health; 1980;.
36 +
The Health Consequences of Involuntary Smoking, a Report of the Surgeon General . Rockville, Md: Office on Smoking and Health; 1986;.
37 +
Smoking and Health: A National Status Report . Rockville, Md: Office on Smoking and Health; 1986;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Slattery ML, Robison LM, Schuman KL, et al.  Cigarette smoking and exposure to passive smoke are risk factors for cervical cancer . JAMA. 1989;;261:1593-1598.
2 +
Winkelstein W.  Smoking and cancer of the uterine cervix: hypothesis . Am J Epidemiol. 1977;;106:257-259.
3 +
Wright NH, Vessey MP, Kenward B, McPherson K, Doll R.  Neoplasia and dysplasia of the cervix uteri and contraception: a possible protective effect of the diaphragm . Br J Cancer. 1978;;38:273-279.
4 +
Naguib SM, Lundin FE, Davis HJ.  Relation of various epidemiologic factors to cervical cancer as determined by a screening program . Obstet Gynecol. 1966;;28:451-459.
5 +
Thomas DB.  An epidemiologic study of carcinoma in situ and squamous dysplasia of the uterine cervix . Am J Epidemiol. 1973;;98:10-28.
6 +
Trevathan E, Layde P, Webster LA, Adams JB, Benigno BB, Ory H.  Cigarette smoking and dysplasia and carcinoma in situ of the uterine cervix . JAMA. 1983;;250:499-502.
7 +
Clarke EA, Hatcher J, McKrown-Eyssen GE, Lickrish GM.  Cervical dysplasia: association with sexual behavior, smoking and oral contraceptive use? Am J Obstet Gynecol. 1985;;151:612-616.
8 +
Harris RWC, Brinton LA, Cowdell RH, et al.  Characteristics of women with dysplasia or carcinoma in situ of the cervix uteri . Br J Cancer. 1980;;42:359-369.
9 +
Wigle DT, Mao Y, Grace M.  Re: 'Smoking and cancer of the uterine cervix: hypothesis.' Am J Epidemiol. 1980;;111:125-127.
10 +
Cederlof R, Friberg L, Hrubec Z, Lorich U. The Relationship of Smoking and Some Social Covariables to Mortality and Cancer Morbidity . Stockholm, Sweden: Karolinska Institute; 1975;:1-91.
11 +
Clarke EA, Morgan RW, Newman AM.  Smoking as a risk factor in cancer of the cervix: additional evidence from a case-control study . Am J Epidemiol. 1982;;115:59-66.
12 +
Kessler II, Kulcar Z, Zimolo A, Grgurevich M, Strnad M, Goodwin BJ.  Cervical cancer in Yugoslavia, II: epidemiologic factors of possible etiologic significance . JNCI. 1974;;53:51-60.
13 +
Williams RR, Horm JW.  Association of cancer sites with tobacco and alcohol consumption and socioeconomic status: interview study from the Third National Cancer Survey . JNCI. 1977;;58:525-547.
14 +
Nischan P, Ebling K, Schindler C.  Smoking and invasive cervical cancer risk: results from a case-control study . Am J Epidemiol , 1988;;128:74-77.
15 +
Celentano DD, Klassen AC, Weisman CS, Rosenshein NB.  The role of contraceptive use in cervical cancer: The Maryland Cervical Cancer Case-Control Study . Am J Epidemiol. 1987;;126:592-604.
16 +
Hirayama T.  Prospective studies on cancer epidemiology based on census population in Japan . In: Bucalossi P, Veronesi U, Cascinelli N, eds. Cancer Epidemiology, Environmental Factors . Amsterdam, the Netherlands: Excerpta Medica; 1975;;3:26-35.
17 +
La Vecchia C, Pranceschi S, Decarli A, Fasoli M, Gentile A, Tognomi G.  Cigarette smoking and the risk of cervical neoplasia . Am J Epidemiol. 1986;;123:22-29.
18 +
Buckley JD, Harris RWC, Doll R, Vessey MP.  Case-control study of the husbands of women with dysplasia or carcinoma of the cervix uteri . Lancet. 1981;;2:1010-1015.
19 +
Hill AB.  The environment and disease: association or causation? Proc R Soc Med. 1965;;58:295-300.
20 +
Mayberry RM.  Cigarette smoking, herpes simplex virus type 2 infection, and cervical abnormalities . Am J Public Health. 1985;;75:676-678.
21 +
Sasson IM, Haley NJ, Hoffmann D, Wynder EL, Hellberg D, Nilsson S.  Cigarette smoking and neoplasia of the uterine cervix: smoke constituents in cervical mucus . N Engl J Med. 1985;;312:315-316.
22 +
Hellberg D, Nilsson S, Haley NJ, Hoffmann D, Wynder E.  Smoking and cervical intraepithelial neoplasia: nicotine and cotinine in serum and cervical mucus in smokers and nonsmokers . Am J Obstet Gynecol. 1988;;158:910-913.
23 +
Schiffman M, Brinton L, Holly E, et al.  Regarding mutagenic mucus in the cervix of smokers . JNCI. 1987;;78:590-591.
24 +
Reducing the Health Consequences of Smoking: 25 Years of Progress, a Report of the Surgeon General . Rockville, Md: Office on Smoking and Health; 1989;.
25 +
Tobacco Smoking . Lyons, France, International Agency for Research on Cancer; 1985;;38:282-292. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans.
26 +
Cramer DW.  Uterine cervix . In: Schottenfeld D, Fraumeni JF, eds. Cancer Epidemiology and Prevention . Philadelphia, Pa: WB Saunders Co; 1982;:881-900.
27 +
Josey WE, Nahmias AJ, Naib ZM.  Viruses and cancer of the lower genital tract . Cancer. 1976;;38:526-533.
28 +
Grubb GS.  Human papillomavirus and cervical neoplasia: epidemiological considerations . Int J Epidemiol. 1986;;15:1-7.
29 +
Tokahuta GK.  Tobacco and cancer of the genitalia among married women . Am J Public Health. 1967;;57:830-839.
30 +
Greenland S.  The effect of misclassification in the presence of covariates . Am J Epidemiol. 1980;;112:564-569.
31 +
Kelsey JL, Thompson WD, Evans AS. Methods in Observational Epidemiology . New York, NY: Oxford University Press Inc; 1986;:297-300.
32 +
Schlesselman JJ. Case Control Studies: Design, Conduct and Analysis . New York, NY: Oxford University Press Inc; 1982;.
33 +
Zunzunegui MV, King MC, Coria CF, Charlet J.  Male influences on cervical cancer risk . Am J Epidemiol. 1986;;123:302-307.
34 +
Hellberg D, Valentin J, Nilsson S.  Smoking and cervical intraepithelial neoplasia . Acta Obstet Gynecol Scand. 1986;;65:625-631.
35 +
The Health Consequences of Smoking for Women, a Report of the Surgeon General . Rockville, Md: Office on Smoking and Health; 1980;.
36 +
The Health Consequences of Involuntary Smoking, a Report of the Surgeon General . Rockville, Md: Office on Smoking and Health; 1986;.
37 +
Smoking and Health: A National Status Report . Rockville, Md: Office on Smoking and Health; 1986;.

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