Associations between Smoking, Screening, and Death Caused by Cervical Cancer in Korean Women

PURPOSE: Cervical cancer is a major women's health problem in the world today. The purpose of this study was to estimate the incidence and mortality rates and to investigate risk factors for cervical cancer in Korean women. MATERIALS AND METHODS: Reproductive factors, cigarette smoking, as well as the risk of incidence and death from cervical cancer were examined in a 12-year prospective cohort study of 475,398 Korean women aged 30 to 95 years who received health insurance from the National Health Insurance Corporation and who had a medical evaluation in 1992. Relative risks (RR) and 95% confidence intervals (CI) were calculated using the Cox proportional hazards model after adjusting for age, body mass index, cigarette smoking, alcohol use, menarche, parity, and Papanicolaou test status. RESULTS: This study showed that the RR of death due to cervical cancer among current smokers was two times higher compared with non-smokers (RR = 2.00; 95% CI, 1.23-2.91). In addition, the RR of death due to cervical cancer among all women who smoked ≥ 10 cigarettes/day was 2.4 times higher than the RR among women that had never smoked. More interestingly, those who had never been screened by Papanicolaou smears had twice the risk of death due to cervical cancer (RR = 2.00; 95% CI, 1.37-1.81). CONCLUSION: Our prospective study concluded that current smokers had an increased risk of death due to cervical cancer. We suggest that the target age group for cervical cancer screening tests be reconsidered and should begin as early as possible.