MARITAL STABILITY AND CANCER OF THE UTERINE CERVIX - CHANGING PATTERNS IN POSTWAR BRITAIN

This study investigates the extent to which the distinctive cross-sect ional marital status picture of risk for cancer of the uterine cervix (single, married, widowed, divorced in ascending order of risk) has pe rsisted in post-war Britain. Incidence and mortality due to invasive c ervical cancer amongst single women now exceeds that of the married, a nd for both has become much closer to that of the widowed and divorced . A dramatic increase in carcinoma in situ in Scotland, seen particula rly 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, t he distribution of screening and hysterectomy cannot account for the p resent day pattern of the disease. Available data on patterns of smoki ng and oral contraceptive use are broadly consistent with a role for t hem in determining the current disease pattern associated with marital status but their possible involvement cannot be disentangled from the more likely effect of changing levels of sexual activity increasing t he risk of sexually transmitted disease. As marital status becomes a l ess important social indicator of sexual behaviour, it has also become a much less reliable marker of cervical cancer risk.