La Vecchia C
Biomed Pharmacother. 1985;39(8):426-33.
Controversial topics in the epidemiology of cervical neoplasia are reviewed, in the light of data from studies conducted in Italy and indications from the literature. The downward trends registered over the last three decades in mortality from cervical cancer seem to be levelling off in the younger age groups (below age 45). This may be partly due to changes in sexual habits in younger women, but is certainly attributable to deficiencies in cervical screening. Pap smear, in fact, strongly reduces the risk of cervical neoplasia, the protection (as suggested by data from a case control study), being long lasting (over five years and perhaps around 10-15 years) for invasive cancers. The results of the same case-control study indicate that, although women with pre-invasive and invasive conditions seem to share several unspecific indicators of sexual habits (i.e., total number of partners and age at first intercourse), they appear to differ with regard to clinical history of specific venereal disease. In fact, genital warts, herpes genitalis and trichomoniasis were more frequent in cases of intraepithelial neoplasia, but not of invasive cancer. The implications of these findings, and of other controversial points in the epidemiology of cervical neoplasia, such as oral contraceptives, cigarette smoking and diet, are discussed with regard to indications from other disciplines (chiefly molecular hybridization and stochastic models of carcinogenesis).
结合意大利开展的研究数据及文献中的相关指征，对宫颈癌流行病学中的争议性话题进行了综述。过去三十年里，宫颈癌死亡率呈下降趋势，但在较年轻年龄组（45岁以下）中这一趋势似乎趋于平稳。这可能部分归因于年轻女性性行为习惯的改变，但肯定也与宫颈癌筛查的不足有关。事实上，巴氏涂片检查能大幅降低宫颈癌变风险，一项病例对照研究的数据显示，对于浸润性癌症，这种保护作用（持续时间长达五年，可能约为10至15年）。同一病例对照研究的结果表明，尽管患有癌前病变和浸润性病变的女性似乎有一些共同的性行为非特异性指标（即性伴侣总数和首次性交年龄），但她们在特定性病的临床病史方面似乎存在差异。实际上，尖锐湿疣、生殖器疱疹和滴虫病在宫颈上皮内瘤变病例中更为常见，但在浸润性癌症病例中并非如此。结合其他学科（主要是分子杂交和致癌作用的随机模型）的指征，讨论了这些发现以及宫颈癌流行病学中其他争议点（如口服避孕药、吸烟和饮食）的影响。
