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PubMed2006

Long-term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia.

Invasive cancer of the cervix after treatment for cervical intraepithelial neoplasia (CIN) is becoming more important, as screening reduces the incidence of invasive disease. The rate of invasive cervical or vaginal cancer following treatment for CIN in UK remains elevated for at least 8 years. The aim of our study was to determine from international data how long this rate remains elevated and whether the rate of invasive disease reflects the rate of posttreatment CIN. The aim was to determine why the rate of invasive disease does not fall. A search of Medline and a secondary search of cited references identified 1,848 articles referring to the success rate of the treatment of CIN. Only 26 cohorts from 25 articles met all the inclusion criteria. The policy in these was to perform at least annual smears. After the first year following treatment for CIN, the rate of invasive disease remained about 56 per 100,000 woman years until at least 20 years after treatment. This rate is approximately 2.8 times greater than expected. In contrast, the risk of posttreatment CIN declined steadily with time to about 190 per 100,000 women in the 10th year. Although the posttreatment rate of CIN falls with time, the rate of invasive disease remains static. It seems likely that this is due to diminishing compliance with follow-up. Women should be encouraged to persevere with annual smears for at least 10 years after their treatment as this may offer them the best chance of detecting recurrence at a treatable stage.

Cohort Studies↗
PubMed1990

Cervical cancers diagnosed after negative results on cervical cytology: perspective in the 1980s.

OBJECTIVES: To assess the magnitude of the problem of interval cancers of the cervix (those that are diagnosed within a short time after negative screening test results) in the 1980s, to compare the nature of interval cancers in younger women with that in older women, and, by reviewing negative cervical smears, to determine the proportion of interval cancers that might represent the development of malignancy anew compared with the proportion that might be associated with difficulties in sampling or errors in reporting. DESIGN: An audit of the interval cases of cervical cancer that had been diagnosed within 36 months of a smear having been reported as negative by the Victorian Cytology Gynaecological Service among women registered with cervical cancer during 1982-6. SETTING: The Victorian Cytology Gynaecological Service, a free public sector cytology laboratory in Victoria, Australia. SUBJECTS: 138 Women, all of whom had had cervical cancer diagnosed during the 36 months after having had a negative cervical smear. Subjects were divided into two age groups: younger women, aged less than 35; older women, aged 35-69. INTERVENTIONS: Negative slides were reviewed for evidence of optimal sampling and for the presence of cellular abnormalities that had been missed at the time of the original reporting. MAIN OUTCOME MEASURES: The number of interval cases of cancer of the cervix registered during 1982-6. The proportion of interval cases occurring in younger women and the proportion occurring in older women. Division of women into three risk categories based on clinical history and screening history that broadly corresponded to the probability that a diagnosis of cervical cancer might be expected during the 36 months after the issuing of a negative smear report. RESULTS: 138 Of 1044 (13.2%) women who had been registered with cervical cancer during 1982-6 had had one or more negative smears during the 36 months preceding the diagnosis of cancer. Interval cancers comprised a larger proportion of registrations of cervical cancer in women aged less than 35 years than in women aged 35-69 (21.1% v 11.0%, p less than 0.01). Women with interval cancer who had had at least three negative smears during the 10 years before the diagnosis of cancer were commoner in the younger age group than in the older age group (7.0% v 2.5%, p less than 0.01). When, however, the number of observed cases of squamous cell carcinoma was related to the number of expected cases in the absence of screening, no significant difference was found between the two age groups (6.8% v 4.8%, p greater than 0.10). The rate of diagnosis of interval cancer per 100,000 negative tests was lower among younger women than among older women (10/100,000 v 16/100,000). Review of the negative slides showed that 11.9% were again considered to be negative with an optimal sample having been obtained as evidenced by the presence of endocervical cells or metaplastic cells, or both. CONCLUSIONS: Interval cancers might comprise a larger proportion of all registered cases of cervical cancer among younger women owing to the larger proportion of such cancers being prevented in this age group. Among women with interval cancer review of the negative slides showed that most were accounted for by suboptimal sampling or by errors of reporting.

Adult↗
PubMed2006

Nonattendance is still the main limitation for the effectiveness of screening for cervical cancer in the Netherlands.

Although mass screening for cervical cancer has been operational for more than 2 decades in the Netherlands, 700 women are still diagnosed with this cancer each year (9 per 100,000). We investigated these cases, in order to evaluate opportunities to further increase the effectiveness of the programme. We analyzed the screening history of women diagnosed with cervical cancer between 1994-1997 using the Dutch national pathology file that includes cervical cytology and histological results. More than half of the cases did not have previous preventive cervical smears, and another 30% had never been invited to the programme because of their age. In the future, we estimate that two thirds of all Dutch women with invasive cervical cancer will be unscreened or under-screened, based on current screening participation of more than 70%. We conclude that increasing screening participation has much more potential for further reducing cervical cancer incidence than reducing the screening interval, increasing the age range or having a screening test with higher sensitivity.

Age Factors↗
PubMed2006

Reduced incidence of cervical cancer in mothers of sons with allergic rhinoconjunctivitis, asthma or eczema.

Because infection with human papillomavirus is a necessary cause of cervical cancer, it is likely that host immunological factors involved in defense against such infections are important for susceptibility to this cancer. By examining associations between allergy in sons and cervical cancer in their mothers, we aimed to test for genetic components involved in both allergy and cervical cancer development. Women born in Sweden between 1932 and 1960 with at least 1 son with medical records from military conscription examination were included in the study (N = 717,963). Among these women there were 41,910 in situ and 3,618 invasive cases of cervical cancer. Hazard ratios of in situ and invasive cervical cancer were estimated as functions of allergic rhinoconjunctivitis, asthma and eczema diagnoses in sons. Adjustment was made for the possible confounders: age, year of birth, education, socio-economic index, geography, number of conscripted sons and total number of offspring. The risk of in situ and invasive cervical cancer was lower for women having sons diagnosed with hypersensitivity (allergic rhinoconjunctivitis, asthma or eczema). Fully adjusted hazard ratios for women with 1 hypersensitive son were for in situ 0.86 (95% CI 0.84-0.88) and for invasive cervical cancer 0.82 (95% CI 0.74-0.91). The protective effects were similar between the 3 allergic diagnoses and increased with number of sons with a diagnosis. There was no significant association between non-cervical cancer in mothers and allergy in sons. These results strengthen the hypothesis that inherited immunological factors are important in determining risk of cervical cancer, probably by affecting mechanisms for viral persistence.

Adolescent↗
PubMedDate not supplied

A nurse-delivered intervention to reduce barriers to breast and cervical cancer screening in Chicago inner city clinics.

An 18-month intervention was implemented to increase breast and cervical cancer screening among poor African-American women in Chicago. Breast and cervical cancer screening programs were set up in two public clinics, one community-based and the other hospital-based. Nurse clinicians and public health workers were used in these programs to recruit women in the clinics and in targeted community institutions to receive free breast and cervical cancer screening. The following barriers were specifically addressed by the intervention: accessibility of screening, knowledge about breast and cervical cancers, access to followup screening examinations, and access to treatment. A computerized followup system was specifically designed to track patients. During the 18 months of the intervention, 10,829 visits were made by 7,654 low-income women. A total of 84 cases of breast cancer and 9 cases of cervical cancer were detected. Awareness of the program, as measured by a survey after the completion of the intervention, increased in both clinics compared with baseline results. Knowledge about breast and cervical cancers also increased, as measured by scores on tests given before and after a class on breast and cervical cancers. Followup rates were 86 percent for women attending the programs. More than 90 percent of the women referred for evaluation of breast abnormalities kept an appointment. In summary, the intervention was successful in reducing barriers to breast and cervical cancer detection and in attracting a high-risk group of women.

Adult↗
PubMed1997

Sexual risk factors for cervical cancer among rural Indian women: a case-control study.

BACKGROUND: The association between sexual behaviour and cervical cancer is well established. Despite a high incidence of cervical cancer in India, its role has not been widely investigated in Indian women among whom the rate of sexual promiscuity is known to be very low. A hospital-based case-control study was carried out to investigate the role of sexual risk factors in cervical cancer among rural Indian women. METHODS: A case-control design was used in which a total of 268 subjects, comprising 134 women with invasive cervical cancer as cases and 134 control women were studied. A multiple logistic regression model was used to analyse the data. RESULTS: The risk factors found to be associated with cervical cancer were early age at first coitus, extramarital sex partners of women and the time interval since first exposure. In a multiple logistic regression model, independent effects were observed for early age at first coitus, showing maximum risk in women who reported their first intercourse at < 12 years of age, compared to that of women at > or = 18 years (odds ratio [OR] = 3.5. 95% confidence interval [CI]: 1.1-10.9). Increased risk was also seen for women who had extramarital sex relationships (OR = 5.5, 95% CI: 1.5-19.5). The significant effect of early age at first coitus persisted after adjustment for latency period which also showed its independent risk association with cervical cancer in the multivariate analysis. CONCLUSION: These findings confirm the association between early age at first coitus and cervical cancer in women with a low rate of sexual promiscuity and define the role of these risk factors in cervical carcinogenesis among rural Indian women.

Adult↗
PubMed1994

Incidence, mortality and survival from invasive cervical cancer in Vaud, Switzerland, 1974-1991.

BACKGROUND: Several factors have contributed to the substantial decline in mortality from cervical cancer registered in most areas of the world, i.e., improved sexual hygiene, changes in reproductive factors, cervical screening, and, possibly, improved treatment. Each of these components is evaluated through a systematic inspection of trends in incidence, mortality and survival rates registered for a well-defined population. PATIENTS AND METHODS: Trends in incidence, mortality and survival from invasive cervical cancer over the period 1974-1991 were analysed for three separate age groups (< 55, 55-64, > or = 65 years), histological type and stage using data from the Cancer Registry of the Swiss Canton of Vaud. RESULTS: Below age 55, the age-standardized (world standard) incidence rate was 9.3/100,000 women in 1974-76, it declined steadily thereafter down to 2.9 in 1986-88, but increased to 4.3 in 1989-91. In the age group 55-64, cervical cancer incidence remained around 40/100,000 to the end of the 1970s, but thereafter declined to 10.9 in 1989-91. No consistent trend was observed in elderly women, and the rate in 1989-91 (26.7/100,000) was similar to that in 1974-76 (33.7). The overall age-standardized cervical cancer incidence declined from 13.5/100,000 in 1974-76 to 5.8 in 1986-88, but rose to 6.4 in 1989-91. A similar pattern was observed for mortality, with a fall in rates in younger women between 1974 and 1985 (from 2.1 to 0.6/100,000), and a subsequent rise to 1.1/100,000 in 1989-91. A substantial decline in mortality was observed in women aged 55 to 64 since the early 1980's, from 17.2 in 1980-82 to 3.3 in 1989-91. No clear mortality trend was evident in older women. Overall, cervical cancer mortality declined from 4.3/100,000 in 1974-76 to 2.3 in 1989-91. The five-year relative survival rates were around 0.70-0.75 for younger women, around 0.60 for those aged 55 to 64, and 0.50 for elderly ones. In a Cox proportional hazard model, age and clinical stage were significantly related to survival, but not histological type and calendar period of diagnosis. No substantial change in survival from invasive cervical cancer was observed over the 18-year period considered, nor was there any notable change in the stage distribution over time. The proportion of adenocarcinomas, however, appears to have increased in the most recent calendar period. CONCLUSIONS: These data reflect the impact of screening on cervical cancer rates, which, however, appeared restricted to women below age 65. An upward trend in cervical cancer incidence and mortality rates for younger women was also apparent, and there was no indication from these data of an improved survival for invasive cervical cancer patients over the last two decades. Extention of screening to elderly women appears to be a priority for reducing cervical cancer rates in this population.

Adenocarcinoma↗
PubMed1986

Clinical significance of statistical discrimination employing serum TA-4, TPA, and CEA levels in uterine cervical cancer.

The serum levels of TA-4, TPA, and CEA were measured simultaneously in 52 patients with uterine cervical cancer and 99 healthy females. The findings were examined statistically by discriminant analysis method. The diagnostic usefulness of discriminant analysis employing the serum values for these three tumor markers was studied for uterine cervical cancer and compared with the diagnostic efficacy using each tumor marker alone. The following results were obtained: In the uterine cervical cancer patients, the frequencies of cases with the elevated serum levels were 55.8% for TA-4, 46.2% for TPA, and 36.5% for CEA. The functional formula, Z = 1.8395 log TA-4 + 3.5314 log TPA + 1.0130 log CEA-7.7352, was obtained by the stepwise discriminant analysis method. With the values obtained from this formula, 71.2% of patients with uterine cervical cancer were correctly classified in the uterine cervical cancer group. In the uterine cervical cancer patients, the values obtained from this formula increased according to the progression of the clinical stage and reflected the disappearance or persistence of tumor lesions after several therapies. From the above results, it was concluded that the discriminant analysis employing the serum values for three tumor markers was extremely useful in determining complete remission of uterine cervical cancers after several therapies, as well as for early diagnosis of the recurrences in uterine cervical cancer which were not detected by the cytologic smear examinations, compared with the measurement for each tumor marker alone. This discriminant analysis, however, was less effective for early diagnosis of uterine cervical cancer than the cervical cytologic smear test.

Analysis of Variance↗
PubMed1992

Roles of Langerhans' cells and T-lymphocytes infiltrating cancer tissues in patients treated by radiation therapy for cervical cancer.

Correlations between infiltration of immunologic cells in tumor tissues and prognosis of radiation therapy were investigated for 275 patients with cervical cancer who were treated with radiation therapy alone, including 216 patients with Stage III squamous cell carcinomas and 59 with adenocarcinomas of all stages. Langerhans' cell (LC) and T-cell were stained immunohistochemically on the specimens excised from the cervical cancer. In squamous cell carcinoma, 5-year survival rates for patients with LC infiltration were significantly better than those without LC (78% versus 60%; P < 0.01). The 5-year survival rate of patients with T-cell infiltration also was significantly better than that of patients without such infiltration (83% versus 61%; P < 0.05). Similar trends were observed in patients with adenocarcinoma; 5-year survival rates for patients with LC infiltration and those without LC infiltration were 49% and 25%, respectively (P < 0.025). The survival rates for patients with T-cell infiltration and those without were 50% and 33%, respectively (P < 0.1). An analysis of patterns of failure of radiation therapy demonstrated that the favorable prognosis in LC infiltration was attributable mainly to improvement of local control rates, but that in T-cell infiltration was not. T-cells infiltrated into tumor specifically in the patients with LC infiltration in both cell types. The authors suggest that the host anti-cancer immune response of individual patients may be remarkably different at the first step of antigen recognition by LC. The LC may induce T-cell-mediated antitumor response and improve local response in radiation therapy.

Adenocarcinoma↗
PubMed2002

[Evaluation of diagnostic methods and characteristics of patients operated on for cervical cancer in Lithuania, 1998-2000].

The total number of new cases of cervical cancer for the three-year period was 1392 patients. The number of cases was fairly evenly distributed among the years of the study period 1998-2000. The total number of new cases of Stages I and II of cervical cancer was 713 (51.2%) cases, and that of Stages III and IV was 623 (44.8%) cases. The number of the new cases with an unknown stage of the disease was found to be 56 (4.0%) cases. The number of patients with Stage IIIB disease was the highest (69 cases) among all the stages of cervical cancer for the study period 1998-2000. The second most common stage was Stage IB disease with 52 patients belonging to this category. One-half (50.0%) of all operated patients because of cervical cancer during the study period 1998-2000 were women of 44 years of age and younger. Therefore, major considerations are to be given for women of reproductive age where effective screening and early detection of cervical pathology could help to avoid a lot of invasive cases of the disease and thus decrease mortality due to it. Generally, the diagnostic work-up and examinations of cervical cancer patients were insufficient, especially in cases of advanced stage disease. Stages III and IV were diagnosed in 44.8% of all cases. Overall, cystoscopy was performed in 39.4% (42 cases) of the total number of cases in Stages IIB through IVA of cervical cancer. Overall, rectosigmoidoscopy was performed in 6.4% (7 cases) of the total number of cases in Stages IIB through IVA of the disease. Finally, the proportion of CT that was performed in cases of Stages IIB through IVB of cervical cancer was 8.4% only. Clinical staging correlates well with pathologic staging in Stage I, particularly Stage IA (88.91%). The data also indicates that parametrial involvement would seem to be the most difficult problem, as 28.59% of Stage IIB and 32.3% of Stage IIIB were down-staged on the basis of pathological findings. This would suggest that in some cases the basic clinical staging rules are not being followed, or clearly understood. Kappa statistics (p = 0.05), diagnostic agreement 86.9% +/- 8%.

Adenocarcinoma↗
PubMed1997

Age-period-cohort analysis of cervical cancer mortality in Taiwan, 1974-1992.

OBJECTIVES: To develop a hypothesis about the carcinogenesis of cervical cancer from a descriptive analysis. METHODS: The mortality data of cervical cancer were analyzed over the period from 1974 to 1992 among Taiwanese women using a log-linear Poisson model modified from the method of Osmond and Gardner to examine the effects of age, calendar period of death, and birth cohort on cervical cancer mortality. RESULTS: This age-period-cohort model provides a summary guide for interpretation of cancer mortality trends. According to this model, age was found to be the strongest factor predicting cervical cancer mortality. Women in 50-54 age group have 89.3-fold risk of cervical cancer compared to those in the 30-34 age group. The cohort effect is also of particular interest because the generation at greatest risk for cervical cancer is the one born between 1893 and 1938, and a dramatically declining trend is observed thereafter for 1938-1963 birth cohort. Interest has emerged about the increasing trend in recent cohorts (after 1963 birth cohort). However calendar time only has a slight effect in the APC analysis. The model also identified a possible role of female sex hormones as the age effect, promiscuous sexual activity as the period effect (promoter) and the change in reproductive behavior as the cohort effect (initiator). CONCLUSIONS: These results may help to develop a hypothesis of carcinogenesis of cervical cancer in Taiwan.

Adult↗
PubMed2004

"Good health for new years": development of a cervical cancer control outreach program for Vietnamese immigrants.

BACKGROUND: Cervical cancer incidence rates are higher among Vietnamese American women than among any other race/ethnic group in the United States. High rates of cervical cancer are associated with low rates of Papanicolao (Pap) testing adherence. METHODS: Twenty-five qualitative interviews and 5 focus groups were conducted with Vietnamese women. RESULTS: Interviews and focus groups revealed unanticipated information about sociocultural influences on women's beliefs about risk factors for cervical cancer. These data were utilized to develop culturally appropriate outreach materials. CONCLUSIONS: Engaging with the target community enabled the development of culturally appropriate materials addressing cervical cancer risk factors and encouraging Pap testing adherence.

Adult↗
PubMedDate not supplied

Synergy between sexual abuse and cervical cancer in causing sexual dysfunction.

Experiencing a sexual abuse creates a life-long traumatic memory. The life-long effect of such abuse on sexuality, well-being, the risk of contracting cervical cancer, or problems after treatment for cervical cancer is not known. A population-based follow-up study in 1996-97 that used an anonymous postal questionnaire for data collection, 256 women with stage IB-IIA cervical cancer registered in 1991-92 in Sweden, and 350 women without cervical cancer frequency matched for age and region of residence, provided information. Among the women with a history of cervical cancer and the control women, 46 (18%) and 50 (15%), respectively, reported a history of sexual abuse. The follow-up was 1-70 years after the sexual abuse. The relative risk (with 95% confidence interval) of decreased well-being was 2.4 (1.1-5.2) among controls and 2.7 (1.1-6.4) among former cervical cancer patients. A history of both sexual abuse and cervical cancer gave a relative risk of 30.0 (7.0-129.0) for superficial dyspareunia. Sexual abuse increased the risk of sexual problems after treatment. The sexually abused cervical cancer patients were generally less willing than other patients to trade off possible maximal survival and forgo parts of the treatment. A history of sexual abuse and cervical cancer are both independent risk factors for sexual dysfunction and decreased well-being, and there may be a large synergy when both factors are combined. Diagnosis and treatment of cervical cancer may be improved by recognition of a sexual abuse history.

Adult↗
PubMedDate not supplied

Pap smear screening in family physicians' offices in a rural area with a high cervical cancer rate.

BACKGROUND AND OBJECTIVES: Cervical cancer, when detected early by methods like the Pap test, is usually curable. Unfortunately, Pap smear screening is not universal, and mortality from cervical cancer still occurs. The objective of this study was to identify the extent to which female patients were not receiving annual Pap tests in nine family physicians' offices in the lower Rio Grande Valley region of Texas. METHODS: Patients age 18 or older were asked the date of their last Pap test. The answer was recorded on a chart sticker to help the physician identify patients in need of a Pap test. RESULTS: Of 5,526 women seen in the nine physicians' offices over a 3-month time period, 42% had not had a Pap smear within the previous 2 years. When offered a Pap test during this study, only 18% of patients refused. CONCLUSION: There appears to be a need for education of physicians and patients about the importance of Pap smear testing and a change in office routines that encourages incorporation of Pap testing into primary physicians' office practices.

Adolescent↗
PubMed1997

Expression of basic fibroblast growth factor and its mRNA in advanced uterine cervical cancers.

To know the potential of growth, invasion and metastasis of uterine cervical cancer cells associated with neovascularization, the expression of basic fibroblast growth factor (FGF) and its mRNA in uterine cervical cancers and normal uterine cervices as controls were determined by enzyme-linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction-Southern blot (RT-PCR-SB), respectively. Then, the relations between the expression and the histological grading and clinical staging in cervical cancers were analyzed. The levels of basic FGF and its mRNA were significantly higher in advanced primary uterine cervical cancers, regardless of histological type. Therefore, this status might contribute to the acceleration of growth, invasion, and metastasis with neovascularization in advanced uterine cervical cancers.

Adult↗
PubMed2004

Cervical cancer in Iquitos, Peru: local realities to guide prevention planning.

Cervical cancer is a major public health problem in Latin America, and in much of the underdeveloped world. This issue has not historically been addressed as a health priority, but in recent years is receiving increased attention and funding. This ethnographic study on the experience of cervical cancer was conducted in Iquitos, Peru, between August 1998 and May 1999. Research methodologies included: (1) observation and household interviews to obtain background knowledge about the region, medical systems, and local cultural understanding of illness; (2) cancer experience interviews; and (3) case studies of women in various stages of cervical cancer or diagnosis. Findings are presented related to local knowledge and experience of Pap smears and cervical cancer and the ineffectiveness of a recently initiated cervical cancer screening program. The findings guide recommendations for interventions in the region in relation to: (1) needed changes in health education, (2) screening frequency and age, (3) sites for screening and treatment, (4) type and availability of treatment, (5) payment issues, (6) documentation of care, and (7) the potential of herbal remedies.

Adult↗
PubMed2004

Socioeconomic deprivation and the incidence of cervical cancer in New Zealand: 1988-1998.

AIM: This study aims to identify the relationship between socioeconomic deprivation and cervical cancer incidence in New Zealand. METHOD: A 10-year cohort of cervical cancer cases was identified from the population-based New Zealand Cancer Registry. The New Zealand Deprivation Index (NZDep96) is a validated census-based measure of material and social deprivation in geographically defined small-population groups. Incidence rates of cervical cancer were correlated with socioeconomic deprivation. RESULTS: There were 2629 new registrations of cervical cancer from 1988 to 1998. A positive association was found between socioeconomic deprivation and incidence rates of cervical cancer. Women living in the most socially and materially deprived areas of New Zealand were more than twice as likely to develop cervical cancer than women living in socially and materially advantaged areas. CONCLUSION: Greater socioeconomic deprivation is associated with an increased incidence of cervical cancer in New Zealand. The link between socioeconomic deprivation and cervical cancer incidence is likely to be complex. The identification of modifiable factors in cervical screening uptake in areas of socioeconomic deprivation should be a research priority.

Adolescent↗
PubMed1989

Cigarette smoking and alcohol consumption in the aetiology of uterine cervical cancer.

A case-control study of uterine cervical cancer was conducted using 331 cases and 993 age-matched controls identified through the Missouri Cancer Registry during 1984-1986. Patients with smoking- or alcohol-related cancers were excluded from the control series. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (Cls) after adjustment for age, cigarette smoking, alcohol consumption, and stage at diagnosis. A dose-response relation was observed between intensity of cigarette smoking and invasive cervical cancer, with light and heavy smokers having elevated risks (OR = 2.2, 95% Cl = 1.4-3.6 and OR = 3.9, 95% Cl = 2.7-5.6, respectively). Former smokers had less elevated risk (OR = 1.7, 95% Cl = 1.0-2.9), a finding consistent with a greater effect of tobacco smoke on late-stage carcinogenesis. Similar results were obtained in age- and control site-specific analyses. Further, the age-specific data suggested a dose-response relation between duration of smoking and invasive cervical cancer. An association between alcohol consumption and invasive cervical cancer was not observed.

Adolescent↗