Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1989 Aug;60(2):238–243. doi: 10.1038/bjc.1989.261

A case-control study of cervix cancer in Singapore.

J Cuzick 1, B De Stavola 1, D McCance 1, T H Ho 1, G Tan 1, H Cheng 1, S Y Chew 1, Y M Salmon 1
PMCID: PMC2247038  PMID: 2548559

Abstract

Cervix cancer is about twice as common in Asia as in the Western world and its incidence varies among different Asian ethnic groups. A study based in Singapore, the population of which comprises Chinese, Indians and Malaysians, offers the opportunity to evaluate whether the same risk factors are important in this part of the world as in the West. A total of 135 cases and an equal number of controls were interviewed and details concerning reproductive and sexual history, smoking, hygiene, socio-economic status and education were collected. Seventy-three cases had invasive cancer while 62 had micro-invasive disease or CIN III. The most important risk factors were parity and number of sexual partners. Smoking was rare in cases and controls and did not appear to be an important determinant of risk. Of the socio-economic factors, education appeared most predictive and lowered the risk. Age at first intercourse was strongly correlated with education (positively) and parity (negatively), but not with number of sexual partners. Biopsies were available for HPV DNA analysis in 38 cases and 37% were positive, mostly for HPV type 16. All these factors gave similar risks in invasive and preinvasive disease.

Full text

PDF
238

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BOYD J. T., DOLL R. A STUDY OF THE AETIOLOGY OF CARCINOMA OF THE CERVIX UTERI. Br J Cancer. 1964 Sep;13:419–434. doi: 10.1038/bjc.1964.49. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barrasso R., De Brux J., Croissant O., Orth G. High prevalence of papillomavirus-associated penile intraepithelial neoplasia in sexual partners of women with cervical intraepithelial neoplasia. N Engl J Med. 1987 Oct 8;317(15):916–923. doi: 10.1056/NEJM198710083171502. [DOI] [PubMed] [Google Scholar]
  3. Beral V. Cancer of the cervix: a sexually transmitted infection? Lancet. 1974 May 25;1(7865):1037–1040. doi: 10.1016/s0140-6736(74)90432-2. [DOI] [PubMed] [Google Scholar]
  4. Brinton L. A., Huggins G. R., Lehman H. F., Mallin K., Savitz D. A., Trapido E., Rosenthal J., Hoover R. Long-term use of oral contraceptives and risk of invasive cervical cancer. Int J Cancer. 1986 Sep 15;38(3):339–344. doi: 10.1002/ijc.2910380307. [DOI] [PubMed] [Google Scholar]
  5. Buckley J. D., Harris R. W., Doll R., Vessey M. P., Williams P. T. Case-control study of the husbands of women with dysplasia or carcinoma of the cervix uteri. Lancet. 1981 Nov 7;2(8254):1010–1015. doi: 10.1016/s0140-6736(81)91215-0. [DOI] [PubMed] [Google Scholar]
  6. Campion M. J., McCance D. J., Cuzick J., Singer A. Progressive potential of mild cervical atypia: prospective cytological, colposcopic, and virological study. Lancet. 1986 Aug 2;2(8501):237–240. doi: 10.1016/s0140-6736(86)92067-2. [DOI] [PubMed] [Google Scholar]
  7. Campion M. J., Singer A., Clarkson P. K., McCance D. J. Increased risk of cervical neoplasia in consorts of men with penile condylomata acuminata. Lancet. 1985 Apr 27;1(8435):943–946. doi: 10.1016/s0140-6736(85)91724-6. [DOI] [PubMed] [Google Scholar]
  8. Dürst M., Gissmann L., Ikenberg H., zur Hausen H. A papillomavirus DNA from a cervical carcinoma and its prevalence in cancer biopsy samples from different geographic regions. Proc Natl Acad Sci U S A. 1983 Jun;80(12):3812–3815. doi: 10.1073/pnas.80.12.3812. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Franceschi S., Doll R., Gallwey J., La Vecchia C., Peto R., Spriggs A. I. Genital warts and cervical neoplasia: an epidemiological study. Br J Cancer. 1983 Nov;48(5):621–628. doi: 10.1038/bjc.1983.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Graham S., Schotz W. Epidemiology of cancer of the cervix in Buffalo, New York. J Natl Cancer Inst. 1979 Jul;63(1):23–27. [PubMed] [Google Scholar]
  11. Grubb G. S. Human papillomavirus and cervical neoplasia: epidemiological considerations. Int J Epidemiol. 1986 Mar;15(1):1–7. doi: 10.1093/ije/15.1.1. [DOI] [PubMed] [Google Scholar]
  12. Harris R. W., Brinton L. A., Cowdell R. H., Skegg D. C., Smith P. G., Vessey M. P., Doll R. Characteristics of women with dysplasia or carcinoma in situ of the cervix uteri. Br J Cancer. 1980 Sep;42(3):359–369. doi: 10.1038/bjc.1980.246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Harris R. W., Forman D., Doll R., Vessey M. P., Wald N. J. Cancer of the cervix uteri and vitamin A. Br J Cancer. 1986 May;53(5):653–659. doi: 10.1038/bjc.1986.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Jussawalla D. J., Deshpande V. A., Standfast S. J. Assessment of risk patterns in cancer of the cervix: a comparison between greater Bombay and western countries. Int J Cancer. 1971 Mar 15;7(2):259–268. doi: 10.1002/ijc.2910070210. [DOI] [PubMed] [Google Scholar]
  15. Kessler I. I. Human cervical cancer as a venereal disease. Cancer Res. 1976 Feb;36(2 Pt 2):783–791. [PubMed] [Google Scholar]
  16. La Vecchia C., Franceschi S., Decarli A., Fasoli M., Gentile A., Parazzini F., Regallo M. Sexual factors, venereal diseases, and the risk of intraepithelial and invasive cervical neoplasia. Cancer. 1986 Aug 15;58(4):935–941. doi: 10.1002/1097-0142(19860815)58:4<935::aid-cncr2820580422>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  17. Lorincz A. T., Temple G. F., Kurman R. J., Jenson A. B., Lancaster W. D. Oncogenic association of specific human papillomavirus types with cervical neoplasia. J Natl Cancer Inst. 1987 Oct;79(4):671–677. [PubMed] [Google Scholar]
  18. MacLennan R., Da Costa J., Day N. E., Law C. H., Ng Y. K., Shanmugaratnam K. Risk factors for lung cancer in Singapore Chinese, a population with high female incidence rates. Int J Cancer. 1977 Dec 15;20(6):854–860. doi: 10.1002/ijc.2910200606. [DOI] [PubMed] [Google Scholar]
  19. Marshall J. R., Graham S., Byers T., Swanson M., Brasure J. Diet and smoking in the epidemiology of cancer of the cervix. J Natl Cancer Inst. 1983 May;70(5):847–851. [PubMed] [Google Scholar]
  20. Martin C. E. Epidemiology of cancer of the cervix. II. Marital and coital factors in cervical cancer. Am J Public Health Nations Health. 1967 May;57(5):803–814. doi: 10.2105/ajph.57.5.803. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. McCance D. J., Campion M. J., Clarkson P. K., Chesters P. M., Jenkins D., Singer A. Prevalence of human papillomavirus type 16 DNA sequences in cervical intraepithelial neoplasia and invasive carcinoma of the cervix. Br J Obstet Gynaecol. 1985 Nov;92(11):1101–1105. doi: 10.1111/j.1471-0528.1985.tb03019.x. [DOI] [PubMed] [Google Scholar]
  22. Muñoz N., Bosch X., Kaldor J. M. Does human papillomavirus cause cervical cancer? The state of the epidemiological evidence. Br J Cancer. 1988 Jan;57(1):1–5. doi: 10.1038/bjc.1988.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Peters R. K., Thomas D., Hagan D. G., Mack T. M., Henderson B. E. Risk factors for invasive cervical cancer among Latinas and non-Latinas in Los Angeles County. J Natl Cancer Inst. 1986 Nov;77(5):1063–1077. [PubMed] [Google Scholar]
  24. Rawls W. E., Lavery C., Marrett L. D., Clarke E. A., Adam E., Melnick J. L., Best J. M., Kraiselburd E., Benedet L. J., Brenes M. M. Comparison of risk factors for cervical cancer in different populations. Int J Cancer. 1986 Apr 15;37(4):537–546. doi: 10.1002/ijc.2910370411. [DOI] [PubMed] [Google Scholar]
  25. Rotkin I. D. A comparison review of key epidemiological studies in cervical cancer related to current searches for transmissible agents. Cancer Res. 1973 Jun;33(6):1353–1367. [PubMed] [Google Scholar]
  26. Rotkin I. D. Adolescent coitus and cervical cancer: associations of related events with increased risk. Cancer Res. 1967 Apr;27(4):603–617. [PubMed] [Google Scholar]
  27. Skegg D. C., Corwin P. A., Paul C., Doll R. Importance of the male factor in cancer of the cervix. Lancet. 1982 Sep 11;2(8298):581–583. doi: 10.1016/s0140-6736(82)90661-4. [DOI] [PubMed] [Google Scholar]
  28. Smith P. G., Kinlen L. J., White G. C., Adelstein A. M., Fox A. J. Mortality of wives of men dying with cancer of the penis. Br J Cancer. 1980 Mar;41(3):422–428. doi: 10.1038/bjc.1980.66. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Vessey M. P., Lawless M., McPherson K., Yeates D. Neoplasia of the cervix uteri and contraception: a possible adverse effect of the pill. Lancet. 1983 Oct 22;2(8356):930–934. doi: 10.1016/s0140-6736(83)90451-8. [DOI] [PubMed] [Google Scholar]
  30. Villa L. L., Lopes A. Human papillomavirus DNA sequences in penile carcinomas in Brazil. Int J Cancer. 1986 Jun 15;37(6):853–855. doi: 10.1002/ijc.2910370610. [DOI] [PubMed] [Google Scholar]
  31. WYNDER E. L., CORNFIELD J., SCHROFF P. D., DORAISWAMI K. R. A study of environmental factors in carcinoma of the cervix. Am J Obstet Gynecol. 1954 Oct;68(4):1016-47; discussion, 1048-52. doi: 10.1016/s0002-9378(16)38400-9. [DOI] [PubMed] [Google Scholar]
  32. Walker P. G., Singer A., Dyson J. L., Oriel J. D. Natural history of cervical epithelial abnormalities in patients with vulval warts. A colposcopic study. Br J Vener Dis. 1983 Oct;59(5):327–329. doi: 10.1136/sti.59.5.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Wangsuphachart V., Thomas D. B., Koetsawang A., Riotton G. Risk factors for invasive cervical cancer and reduction of risk by 'Pap' smears in Thai women. Int J Epidemiol. 1987 Sep;16(3):362–366. doi: 10.1093/ije/16.3.362. [DOI] [PubMed] [Google Scholar]
  34. Zunzunegui M. V., King M. C., Coria C. F., Charlet J. Male influences on cervical cancer risk. Am J Epidemiol. 1986 Feb;123(2):302–307. doi: 10.1093/oxfordjournals.aje.a114238. [DOI] [PubMed] [Google Scholar]
  35. de Villiers E. M., Wagner D., Schneider A., Wesch H., Miklaw H., Wahrendorf J., Papendick U., zur Hausen H. Human papillomavirus infections in women with and without abnormal cervical cytology. Lancet. 1987 Sep 26;2(8561):703–706. doi: 10.1016/s0140-6736(87)91072-5. [DOI] [PubMed] [Google Scholar]
  36. zur Hausen H., Gissmann L., Schlehofer J. R. Viruses in the etiology of human genital cancer. Prog Med Virol. 1984;30:170–186. [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES