Smoking and Cervical Cancer: Cause or Coincidence?

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Abstract
In the debate on the role of cigarette smoking in the etiology of cervical cancer, there is one central point of agreement: women who smoke cigarettes are more likely to develop cervical neoplasia than are nonsmokers. Beyond that key point, however, there is considerable controversy. The basic question is whether the association of smoking and cervical cancer is causal, mediated by some biologically plausible mechanism, or artifactual, produced by some extraneous confounding difference between smokers and nonsmokers. The noteworthy article by Slattery and collegues1in this issue ofThe Journalwill open a new controversy in this area by suggesting an etiologic role of passive exposure to the smoke of others' cigarettes in cervical carcinogenesis. In addition, Slattery and colleagues have reopened the long-standing, more general debate about whether cervical cancer should be added to the list of tobacco-induced cancers. Winkelstein's2insightful recognition of the similarity of cervical