Smoking and Cervical Cancer

Elsewhere in this issue (p 499), Trevathan and colleagues report an association between cigarette smoking and both dysplasia and carcinoma in situ of the uterine cervix. Initially hypothesized in 1977 by Winkelstein,¹the association of invasive cervical cancer and carcinoma in situ with smoking has now been reported by almost every retrospective^2-6and prospective^7,8study in which the investigators sought to detect such a relationship. Trevathan et al now confirm the existence of the same relationship in cervical carcinoma in situ and in its premalignant precursor, dysplasia. Both the work of Trevathan et al and of Lyon et al⁹may be considered second-generation studies because they were undertaken with the primary intent of testing the validity of the previously reported association. Both studies substantiated the association and both found a particularly strong effect from smoking at an early age. Both groups suggest, as a possible biologic