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A Comparison Review of Key Epidemiological Studies in Cervical Cancer Related to Current Searches for Transmissible Agents¹

Department of Preventive Medicine and Community Health, University of Illinois at the Medical Center, Chicago, Illinois 60680

The search for a venereally transmissible oncogenic agent which may show relatedness to onset of cervical cancer rests upon three main evidential currents: demographic demonstration of cultural variables associated with increased risk, epidemiological focus upon sexual factors maximizing risk, and the assumption that cervical cancer begins and develops according to a multistage continuum. For this, an abbreviated model conforming multistage carcinogenesis in the human uterine cervix with the classical animal model introduces an epidemiological review. Assumptions required for this rationale include maximal biological activity in the cervical cellular matrix during adolescence, an oncogenic agent for initiation of neoplasia, and recognition of pivotal events directly related to risk. In reviewing variables and attributes described in the literature, distinction is made between those that are cultural and indirect and those that are biological and may directly transform epithelium. A set of comparison studies is presented in assessing historically described major influences upon risk and each is examined for relevance, using a comparison ratio for detection of excessive frequencies between patients and controls. It is shown that onset of sexuality before age 17 is the most powerfully discriminating variable in virtually all studies where this has been investigated and that a history of multiple sexual consorts is a supporting variable of some strength. Marital variables and those associated with sociosexual stability are cultural and relate to the biological variables of early coitus and multiple sexual partners. Coital frequencies, menstrual patterns, and gravidity seem to bear no discernible risk relationship. Noncircumcision of sexual partners is shown to have been limited in most studies to husbands and in some studies to selected or all coital mates, yet no study reveals differences between patients and controls for exposure to uncircumcised partners. Comparison studies are collected in charts to demonstrate relative strength and consistency of trends.

Cervical cancer is the only solid neoplasm for which epidemiological findings in humans have been adapted to a model developed with laboratory animals, and it is the only tumor that has been studied with regard to a full universe of possible variables and attributes that might alter risk. This has resulted in the currently espoused hypothesis that Herpesvirus hominis type 2 may be an initiating or promoting carcinogenic agent which can be transmitted during coitus by the malc donor to the female host at risk.

¹ Presented at the American Cancer Society Conference on Herpesvirus and Cervical Cancer, December 8 to 10, 1972, Key Biscayne, Fla.

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