AN EPIDEMIOLOGIC AND SEROLOGIC COMPARISON OF UTERINE CARCINOMA IN SITU AND SQUAMOUS DYSPLASIA

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Abstract
Thomas. D. B. and R. I. Anderson (Johns Hopkins U. School of Hygiene and Public Health, Baltimore, Md. 21205). An epidemiologic and serologic comparison of uterine carcinoma in situ and squamous dysplasia. Am J Epidemiol 100:113–123, 1974. —In the winter of 1971–1972, serum for detection of various antibodies was obtained from 79 women with carcinoma in situ, 87 women with squamous dysplasia, and 146 women with normal cytologic smears. All had been interviewed in 1970. The two groups of cases were composed of 15- to 50-year-old white residents of Washington County, Maryland, who first had an abnormal cytologic smear followed by a histologic diagnosis from 1965 to 1969. The controls were a probability sample of women of the same age and race from the same area who had a normal cytologic smear during those same years. Simultaneous adjustment for 12 variables using multiple linear regression revealed trichomonads to be the only factor by which both women with carcinoma in situ and women with squamous dysplasia differ from normal controls. Those with carcinoma in situ were also characterized by marital instability and conception of first child before marriage. In contrast, those with dysplasia were also characterized by a history of vaginal discharge, a low level of education, and the presence of complement-fixing antibodies against cytomegalovirus, adenovirus, her-pesvirus simplex, and Mycoplasma pneumoniae. The relative risk of dysplasia increased with the number of positive tests for trichomonads and antibodies. The descriptions of severe and mild dysplasia were similar. These findings led to the following conclusions: 1) carcinoma in situ is most likely caused by one or more venereally transmitted carcinogens; 2) most dysplasia represents a nonspecific reaction of the cervical epithelium to inflammatory agents; 3) specific agents that may cause dysplasia include Trichomonas vaginalis, cytomegalovirus, and herpesvirus simplex; 4) most dysplasia is not an earlier stage of the same pathologic process as carcinoma in situ; 5) lesions classified as dysplasia that are early stages of the same pathologic process as carcinoma in situ, if any, cannot be distinguished by their severity.

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