de Sanjosé S, Bosch F X, Muñoz N, Shah K
Servei d'Epidemiolog'ia i Registre del Cancer, Institut Catalá d'Oncologia, Ciutat Sanitaria i Universitaria de Bellvitge.
IARC Sci Publ. 1997(138):309-17.
In this chapter we first describe the variation of cervical cancer in relation to social class. Thereafter we examine the causes for the occurrence of socioeconomic differences in invasive cervical cancer, using data from two case-control studies carried out in Colombia and Spain. Cervical cancer is the most common cancer in developing countries and the sixth most common in developed countries. In all areas, it is more frequent among women of low socioeconomic status, it is associated with multiple sexual partners and early age at first sexual intercourse, and both incidence and mortality are reduced by screening. According to population-based surveys in industrialized countries, men of low socioeconomic status report fewer sexual partners than men of high socioeconomic status but there is no clear indication that the same is true of women of low socioeconomic status. In the case-control studies in Spain and Colombia, the human papillomavirus and all other sexually transmitted diseases were more prevalent among women in low socioeconomic strata. Number of sexual partners and particularly contacts with prostitutes were higher among husbands of women of low socioeconomic status. Other potential risk factors for the disease, such as smoking and oral contraceptive use, and also cervical cancer screening (Pap smears), were more common in women of high social strata. Women with no schooling had a threefold higher risk in Spain and a fivefold higher risk in Colombia of having cervical cancer compared with women who had achieved a higher educational level. After adjustment for sexual behaviour, HPV DNA status, history of Pap smears and husband's contact with prostitutes, this association was considerably reduced. These results are indicative that socioeconomic differences in the incidence of cervical cancer can be partly explained by differences in the prevalence of HPV DNA. Men's sexual behaviour and particularly contacts with prostitutes might be a major contributor to the higher prevalence of HPV DNA among the poor.
在本章中，我们首先描述宫颈癌在社会阶层方面的差异。此后，我们利用在哥伦比亚和西班牙开展的两项病例对照研究的数据，探讨浸润性宫颈癌发生社会经济差异的原因。宫颈癌是发展中国家最常见的癌症，在发达国家则是第六大常见癌症。在所有地区，社会经济地位较低的女性中发病率更高，它与多个性伴侣及初次性行为的年龄较早有关，而且筛查可降低发病率和死亡率。根据工业化国家基于人群的调查，社会经济地位较低的男性报告的性伴侣比社会经济地位较高的男性少，但没有明确迹象表明社会经济地位较低的女性也是如此。在西班牙和哥伦比亚的病例对照研究中，人乳头瘤病毒及所有其他性传播疾病在社会经济地位较低阶层的女性中更为普遍。社会经济地位较低的女性的丈夫的性伴侣数量，尤其是与妓女的接触次数更多。该疾病的其他潜在风险因素，如吸烟和使用口服避孕药，以及宫颈癌筛查（巴氏涂片检查），在社会阶层较高的女性中更为常见。在西班牙，未受过教育的女性患宫颈癌的风险是受过较高教育水平女性的三倍，在哥伦比亚则是五倍。在对性行为、人乳头瘤病毒DNA状态、巴氏涂片检查史以及丈夫与妓女的接触情况进行调整后，这种关联大幅降低。这些结果表明，宫颈癌发病率的社会经济差异部分可由人乳头瘤病毒DNA流行率的差异来解释。男性的性行为，尤其是与妓女的接触，可能是导致穷人中人乳头瘤病毒DNA流行率较高的主要因素。
