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I. D. Rotkin
Department of Preventive Medicine and Community Health, University of Illinois at the Medical Center, Chicago, Illinois 60680
"Cervical cancer, humans: herpesvirus type 2 has been postulated as the initiating agent for
Level 2; or as the promoting agent for Level 4: perhaps both.
Table 2
Validity of the model
Step Resolution
StudyLombard Ratio24
(1950)Wynder
and Potter 1.9335313563545491620483128481541429593.6.3.8.2.2.2.4.6.3.3
(1954)WhiteNegroStocks
et al.
(1955)Jones
(1958)Ward
et al.
casesPrivate
casesTotal
casesTerris
white
(1960)Boyd
and Oalmann
(1964)Hospitals
and Doll
BHospitalsA +
AChristopherson
(1965)"Aitken-Swan
and Parker
situ¡Martin and Baird (1966), in
onlyAbou-Daoud
(1967). Jewish
(1967)»ChristianMoslemTerris
(1967)Rotkin
et al.
(1967)Wahi
(I969)1'HinduMuslimPatients45546X24664254712525623143702155649995Controls
et al.
Table 6
Comparison studies of multiple marriages by frequencies of patients and controls
does not hold for Muslim patients, yet this population, gen increases risk of cervical cancer. That the companion bio
erally considered at very low risk, is reported as one-half of logical temporal event is early onset of coitus will be shown
the Hindu prevalence in this screening program. There is in a succeeding comparison study.
little need for further demonstration that early marriage Multiple Marriages (Table 6). Reports covering 9 in-
Table 7
Comparison studies of onset of coitus under ages 20 and 17 in cervical cancer patients and controls
1st coitus
Before age 20
Wynder et al. (1954)
U. S. Hospitals
White 60 175
35
Negro" 85 133
New York
White 55 172
Negro" X6 160
Terris and Oalmann (1961) 79 138
Aitken-Swan and Baird (1966) in situ 63 131
Martin (1967). Jewish 53 154
Rotkin (1967) S2 1Mean
ratio 1.7.1.7.2.3.7.7.5.5
Before age 17
Wynder et al. (1954)
U. S. Hospitals
White 14 10 1.9
Negro" 55 36 1.5
New York
White 17 6 2.8
Negro" 45 28 1.6
Terris and Oalmann (1961), total 53 26 2.0
Terris et al. (1967). total 53 37 1.4
Rotkin (1967)
total samples 51 28 1.8
Subsample I 46 32 1.4
Subsample 2 39 27 1.4
Subsample 3 57 20 2.9
Subsample 4 47 25 1.9
Subsample 5 62 32 1.9
Table 8
Comparison studies of multiple sexual consorts by frequencies for patients and controls
Mean ratio I .7
Table 9
Comparison studies of coital frequencies in cervical cancer patients and controls
% %
Study patients controls Ratio
Table 12
Comparison studies of frequencies of unstable sexual relationships (extramarital and premarital
coitus) by patients and controls
husbandsTerris
Stephenson and Grace (1954),
wivesMartin
and Oalmann (1961),
onlyEver
(1967). Jewish
wivesEver
husbandRotkin
any
(1967)Extramarital,
wivesPremarital,
wives2154102829548266823472.62.11.73.51.3I.I
1Information obtained only from wives for all studies.
study of Christopherson and Parker refers generally to early useful to search for ratios substantially under unity, indi
onset of sexuality. Otherwise, this same study shows ex cating excesses in control groups. For the practice of douch
cesses of multiple pregnancies for controls, and with no ing, Martin's results are directly opposite those of Boyd and
pregnancies for more patients. From my own studies mean Doll, and my data show no substantial difference in frequen
numbers of pregnancies and deliveries are about the same cies of patients and controls who douched. Obstructive types
for patients and controls. For excesses in higher multigravid of contraceptives are associated with controls in several
and multiparous classes of patients, it should be remem studies, perhaps indicating protective shielding against con
bered that these women began their coital lives earlier with taminant carcinogens. The use of rhythm by more controls
more opportunity for additional pregnancies. From this in my samples is not easily explainable except perhaps with
table, it would be difficult to reconcile numbers of preg relation to personality types which might eschew multiple
nancies or deliveries with increased risk of cervical cancer. sexual partners and begin coitus later in life. The only gen
Menstrual Patterns (Table 14). A glance at the ratios eralization possible from this comparison set is that a pro
comparing patients with controls in the 3 studies of this tective barrier may prevent an agent from reaching the
table will rule out any association of age menarche, duration cervix.
menses, interval menses, and irregular menses with in Noncircumcision of Sexual Consorts (Table 16). Schor
creased risk of cervical cancer. All studies are in close con (30), in his textbook on statistics, points out that from differ
cordance and are antithetical to a hypothesis of a pubertà ! ent reports wives, husbands, and^physicians all appear con
hormonal component with effect upon risk. fused in defining circumcision status and that identification
Contraception (Table 15). Several investigators have of circumcision as a statistical unit is highly insecure. To
studied the effect of differential contraceptive practices this can be added the uniformly biased selection of target
upon risk of cervical cancer. In surveying this table, it is populations in most of the circumcision studies relating to
Table 14
Comparison studies of menses in cervical cancer patients and controls
Study Patients Controls Ratio
Boyd
(1964)Mean
and Doll
menarcheHospitals
age
BWith A +
mensesHospital
irregular
AHospital
BAbou-Daoud (14141352815%
(1967)Mean
menarcheChristianMoslemRotkin
age
(1967)Mean
menarcheMean
age
mensesMean
days duration
mensesWith
interval between
irregular menses147%79!14141352812%147%8% (.0.0).9.0.0.0.0.0).8
Terris
(1961)Ever
and Oalmann
usedNever
usedBoyd
(1964)NoneEver
and Doll
sheathEver
doucheEver
obstructionEver
withdrawalEver
chemicalAitken-Swan
(1966)SheathMartin
and Baird
onlyNoneCondomDiaphragmDouche
(1967), Jewish
only)WithdrawalRotkin
(for contraception
(1967)NoneCondomDiaphragmDouche
reasons)WithdrawalRhythmJelly397302157426125461511231662992572432128827262210397206611421636X39835350450.31.11.10.80.20.7
(all
Table 16
Circumcision of coital partners (comparison studies by frequencies)
% coitus with % uncircumcised,
uncircumcised and mixed mixed and half unknown"