title: Effect of smoking cessation on cervical lesion size.
abstract: BACKGROUND
  Cigarette smoking has been postulated as a cofactor in the aetiology of cervical cancer, but a causal role is difficult to establish because of potential confounding by sexual behaviour. We have investigated the effect of cessation or reduction of cigarette smoking on the course of minor-grade cervical lesions.
  
  
  METHODS
  In this intervention study 82 women volunteers with minor-grade lesions on colposcopy (cervical intraepithelial neoplasia grade 1 or less) attempted to give up smoking for 6 months. Smoking histories were taken at 3-monthly clinic visits and verified by measurement of salivary cotinine concentrations. At each clinic visit, a photograph of the cervix was taken; the image was digitised and computer-aided image analysis was used to assess lesion size, by investigators unaware of smoking status.
  
  
  RESULTS
  Of the 82 women, 17 stopped smoking completely for at least 6 months and 11 others reduced their smoking consumption by more than 75%. Of these 28 women, 23 (82%) showed a reduction in lesion size of at least 20% or 4 mm2 compared with 13 (28%) of the 47 non-quitters (odds ratio 12.0 [95% Cl 3.9-32.7]). The remaining seven women had unconfirmed smoking histories. There was a significant correlation between the extent of smoking reduction and the change in lesion size (chi2 for trend=31.55, p<0.0001). Adjustment for social class, method of contraception, and stage of menstrual cycle did not affect the results.
  
  
  CONCLUSIONS
  Our findings support a link between smoking and cervical disease and suggest that smoking cessation could have a beneficial effect on early cervical abnormalities.
authors.affiliation: Department of Mathematics, Statistics, and Epidemiology, University Hospital, Nottingham.
authors.forename: A
authors.initials: A
authors.lastname: Szarewski
authors.forename: M J
authors.initials: MJ
authors.lastname: Jarvis
authors.forename: P
authors.initials: P
authors.lastname: Sasieni
authors.forename: M
authors.initials: M
authors.lastname: Anderson
authors.forename: R
authors.initials: R
authors.lastname: Edwards
authors.forename: S J
authors.initials: SJ
authors.lastname: Steele
authors.forename: J
authors.initials: J
authors.lastname: Guillebaud
authors.forename: J
authors.initials: J
authors.lastname: Cuzick
mesh_terms: D000328:Adult; D003127:Colposcopy; D003367:Cotinine / Q000032:analysis; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D011859:Radiography; D012463:Saliva / Q000737:chemistry; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D012923:Social Class; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D002578:Uterine Cervical Dysplasia / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*
chemical_list: D003367:Cotinine