© 1993 Oxford University Press
research-article |
Marital Stability and Cancer of the Uterine Cervix: Changing Patterns in Post-War Britain
* Unit of Health-Care Epidemiology, (Department of Public Health and Primary Care, University of Oxford), Oxford Regional Health Authority, Old Road, Headington, Oxford OX3 7LF, UK, and Health Statistics Division, Office of Population Censuses and Surveys, St Catherine's House, Kingsway, London WC2B 6JP, UK
** Social Statistics Research Unit, City University Northampton Square, London EC1V OHB, UK
Department of Public Health and Primary Care Gibson Laboratories Building, Oxford OX2 6HE, UK
This study investigates the extent to which the distinctive cross-sectional marital status picture of risk for cancer of the uterine cervix (single, married, widowed, divorced in ascending order of risk) has persisted in post-war Britain. Incidence and mortality due to invasive cervical cancer amongst single women now exceeds that of the married, and for both has become much closer to that of the widowed and divorced. A dramatic increase in carcinoma in situ in Scotland, seen particularly in the single since 1982, must partly reflect changes in screening and diagnostic classification, but is also consistent with the later occurrence of the sexual revolution in Scotland. Overall in Britain, the distribu tion of screening and hysterectomy cannot account for the present day pattern of the disease. Available data on patterns of smoking and oral contraceptive use are broadly consistent with a role for them in determining the current disease pattem associated with marital status but their possible involvement cannot be disentangled from the more likely effect of changing levels of sexual activity increasing the risk of sexually transmitted disease. As marital status becomes a less important social indicator of sexual behaviour, it has also become a much less reliable marker of cervical cancer risk.
Received 1 December 1992