Is Intercourse a Factor?

The brightest chapter in the history of cancer control in the U.S. relates to cancer of the uterus, the second commonest form of the disease in women. Once, it was almost invariably fatal. Now, although 42,000 American women develop the disease each year, two-thirds are saved by surgery. Medical authorities are confident that virtually all the remaining cases could be cured by earlier detection and prompt treatment.

As they analyze the success already achieved, researchers are finding that it resulted not only from cell tests ("Pap smears") but also from many other factors. And in pursuing their search for the causes of the disease, they are amassing evidence suggesting that many, perhaps most cases of uterine cancer are triggered by a common virus transmitted during sexual contact. This does not mean that uterine cancer is either an "infectious" or "venereal" disease in the usual sense; but it does suggest measures by which the disease might, to a great extent, be prevented.

High-Risk Groups. About one-fourth of all uterine cancers invade the body of the womb, usually in older women. The form that attacks the cervix (neck) of the womb may develop in women at any age from the late teens on. Because of both its greater frequency and its threat to women in their childbearing years, this type has received intensive study. The American Cancer Society's Epidemiologist E. Cuyler Hammond lists several social as well as medical factors that go with high cervical cancer rates.

The incidence, he reports, is especially high among prostitutes and the poor, regardless of creed or color. The death rate is twice as high among low-income Negroes as among all whites, but no higher among high-income Negroes than among high-income whites. The incidence among Jewish women generally is extraordinarily low, although it rises a bit among the poor. Cervical cancer is least likely to attack women with fully circumcised husbands.

The disease is especially prevalent among women who have their first sexual experience early in life, and those who have many sex partners; it is somewhat more prevalent among women who have their first pregnancy early. Frequency of sexual intercourse with a single partner does not seem to be related to the disease. A factor unrelated to social class is a woman's medical history; if she reports frequent spotting, inter-menstrual bleeding or discharge, she runs a 3 1/2 times greater-than-average risk of developing uterine cancer.

Hammond's statistical analyses show that uterine cancer deaths began to decline in the 1930s. This was before the Pap smear was in wide use, but after cancer campaigners had begun to stress the seven warning signals. The decline accelerated dramatically with wide use of the Pap smear.

Suspect Virus. A link between cervical cancer and poor hygiene, plus lack of circumcision, would be easier to explain if an infectious agent could be implicated. Researchers at Baylor University have found a suspect. It is a virus technically known as Herpesvirus hominis, Type II, closely related to the herpes virus, Type I, which causes fever blisters around the mouth. Type II infects the genital regions of both sexes; it is found in smegma, the secretion under the foreskin, and is readily transmitted during sexual contact.

The Baylor investigators, headed by Dr. William E. Rawls and Virologist Joseph L. Melnick, found from antibody studies that 83% of cervical cancer patients had been infected with herpes Type II, whereas among other women and other cancer patients they found no incidence higher than 20%. A parallel study at Emory University has yielded similar results: 300 women with Type II antibodies are being studied to see whether they develop an abnormal number of cervical cancers.

So far, Melnick told the New York Academy of Sciences last week, the relationship between the virus and the cancer is only associative, with no proof that it represents cause and effect. But evidence is growing that several forms of human cancer may be triggered by viruses through some yet to be understood mechanism. If a localized virus like herpes Type II could be shown to help cause cervical cancer, steps to control the viral infection should lead to further progress in cancer prevention.

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