When, at the turn of the century, Sinclair1 recorded his clinical impression that cancer of the cervix occurred "among chronically overworked and underfed, among women, poor, prolific, harassed, worried, drained by lactation, reposeless," he clearly pointed to socioeconomic factors as causal determinants.
Clinical observations, however astute, do not build secure foundations for etiologic theories, unless supported by stringently analyzed data obtained from large population samples. Sinclair's impression had to await its turn until modern biostatistical methods and screening techniques caught up with it and subjected the observation to close scrutiny.
Poverty, promiscuity, syphilis, and early pregnancy emerge as significant in the epidemiology of cervical cancer. Even such seemingly independent influences as race and geography derive their significance from these socioeconomic factors. The high incidence of the disease in Negroes was demonstrated by Christopherson and Parker2 to be related not to racial traits, but to the socioeconomic stratum, inasmuch as
EPIDEMIOLOGY OF CERVICAL CANCER: TOUR d'HORIZON. JAMA. 1965;194(2):188–189. doi:10.1001/jama.1965.03090150080022
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