Abstract

PIP: A case control study was conducted to identify various environmental factors associated with cervical cancer and the extent or degree of association of those factors with the disease. The cases were 212 histologically confirmed cervical cancer patients admitted to the gynecological ward in 4 Thailand hospitals. The controls were 212 patients diagnosed with other gynecological conditions except cancer (confirmed by pelvic examination and papanicolaou smear) who were admitted to those hospitals during the same period as the cases. The cases and controls were matched by age, using 5 year intervals. Questionnaires containing information such as sociodemographic data, marital status, pregnancy and delivery history, past history of illness, especially with genital tract infections, and husband's illness history including venereal diseases were distributed. Questionnaires were the same for case and control. Cases and controls were similar in demographic and social characteristics. All cases were younger at 1st intercourse and had a higher number of pregnancies and parity than controls. Various factors presented significantly more in the cases than the controls. The suspected risk factors in cervical cancer were: parity, with cases showing higher parity than control; positive history of vaginal infections; higher number of marriages; younger age at 1st intercourse and history of husband's sexually transmitted disease. Circumcision in the husband indicated a protective factor to this disease, although the number of husbands who had circumcision in this study were very few. The risk factor of highest relative risk value was the marriage factor, followed by factors of high parity. Women who had 3 or more live births were 3 times more prone to cervical cancer than women with lower fertility. Women who had multiple marriages also ran a higher risk to this disease, as did those who had history of vaginal infection and husband's history of sexually transmitted disease. Women with a history of irregular menstruation both of amount and frequency were twice as prone to cervical cancer than normal women. The degree of association between risk factors and cervical cancer as expressed by odd ration was shown by various combinations of the risk factors, such as high parity and positive history of vaginal infection. These 2 characteristics were about 9 times more prone to cervical cancer than women without these characteristics. Women with 4 risk factors combined had the greatest risk compared to those who did not have those factors.