TB: new research on an old disease.

The various factors implicated in the aetiology of cancer of the cervix uteri are, early age at first coitus, multiple sexual partners, infection with viral agents and possibly the circumcision status of the partner. The interreligious differences in the prevalence of some of these factors have been studied in the past to explain the diverse rates of cervical cancer reported in different religious groups in India. Thus, the low rate in Muslims compared to Hindus has been attributed to the religious practice of circumcision in the Muslim males (Wynder et al., 1954; Wahi et al., 1972) and the equally low rate in Christians (compared to Hindus) to the later age at marriage in them (Jayant, 1986). This communication evaluates these findings in the light of more detailed sociocultural profiles in the different religious groups and considers the relationship between two risk factors viz., early age at first coitus and poor penile hygiene. Furthermore, it provides a plausible explanation for Muslims not having as low a cervical cancer rate as Jews although circumcision is a religious practice in both groups. The age-specific incidence rates of cervical cancer in the various religious groups viz., Hindus, Muslims, Christians and Parsis (Zorastrians) (Jussawalla et al., 1985) are shown in Figure 1. The interreligious comparisons are based on the available data on sociocultural practices from several previous studies and the reported age-adjusted rates for cervical and penile cancer in these religious groups as shown in Table I. The main factors leading to differential rates in Hindus and Muslims seem to be 'multiple partners' and 'circumcision status'. In spite of early age at marriage and poor genital hygiene practices in females, the single factor of circumcision in males (and the concomitant better penile hygiene; smegma+ +, 0% Wynder et al., 1954) seems to have resulted in lowering the cervical cancer rate in Muslims to two thirds of the rate in Hindus. It is not possible to say from this comparison whether the rate in Muslims would have been further lowered had the factor of multiple partners been absent. Comparison of the prevalence of factors in Hindus and Christians suggests that higher age at marriage and somewhat better genital hygiene practices in the Christian females has reduced the cervical cancer rate in them (compared to Hindus) by almost the same amount as circumcision has in Muslims despite Christian men not being circumcised and having poor penile hygiene (smegma+ +, 44%). Higher age at marriage may be considered equivalent to higher age at first coitus as a survey in Bombay has shown that the age at consummation of marriage was the same as age at marriage for over 90% of women who married after 14 years and for those who married before 14 years, it was consummated before the 14th birthday in 80% (Rele & Kanitkar, 1980). (Premarital sex was rare in all 3 groups in a study in married women of low socioeconomic stratum). Although personal hygiene of the woman is believed to be of importance (Cramer, 1982), there are as yet no definitive studies on this topic. However, early age at first