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21
Notwithstanding the special conditions of life attendant upon motherhood, Cancer
there is no excess of mortality from cancer of the reproductive system among married mortality in relation to
women, the total mortality in a million of the London standard (life-table) population civil
between 35 and 85 years of age during the decennium 1911-20 for the Group II. condition,
cancers, being among married and widowed women 1,389, and among single women
1,465.
When, however, the Group II. cancers are considered according to locality of
growth in relation to civil condition, remarkable differences of incidence are found.
From Section B of the diagram on page 19, it will be seen that among married
women cancer of the uterus causes nearly twice as many deaths as among the same
number of single women, and that the position is reversed in cancers of the remaining
sites of the group. Figures obtained for the years 1921-26 indicate that the excess
among married and widowed women of uterine cancer is limited to the cervix, but
no data are available for the period 1911-20 in regard to this. If, however, it were
possible to transfer deaths from cancer of the body of the uterus from the upper
curves of Section B to those for the breast, ovary and vagina below, the contrast
in mortality according to civil condition would be still further emphasised. In
the lowest division of Section B of the diagram, the age-distribution of the total
mortality from Group II. cancers is shown to be approximately the same for the
two classes of civil condition.
The conclusion suggested by the data is that exposure of the cervix to specific
carcinogenic conditions associated with primary conception does no more than
determine the locality of attack; so that, again, diathesis appears to be the controlling
factor.
It has not been possible hitherto to examine the relationship between social Cancer
conditions and the mortality of cancer by locality of attack as the necessary data mortality
in relation to
have not been available for each metropolitan borough. The following observations social
are based upon figures which have been supplied by the Registrar-General relating condition,
to the six years, 1921-26.
For the purpose of contrast in social condition or environment, two groups of
boroughs have been selected, one, representing the better-class population, comprising
Hampstead, Lewisham and Wandsworth, with a total population in 1921 of 588,654
(Group A), and the other, the boroughs of Bermondsey, Bethnal Green, Finsbury,
Shoreditch and Stepney, with a population of 666,590, representing the poorer classes
(Group B). In the latter group there is a higher proportion of Jewish residents
among whom the mortality from cancer is thought to be relatively lower than in
the general population ; there are also far more aliens in this group than in Group I.,
and this fact also tends to qualify any but broad deductions from the data. The
calculation of corrected mortality figures for each borough, according to site of
primary growth, must be deferred until the results of the next census are available
for the purpose.
As the number of deaths for most of the single localities is insufficient to give
representative rates for such relatively small populations, the localities for which
figures have been obtained are grouped so as to approximate to the groups formed
for the purpose of the analysis of cancer mortality by sex-ratio in London in 1911-20.
Thus cancers of the lip, tongue, larynx and oesophagus are taken to represent
Group I., the localities of the alimentary tract above the diaphragm; while
cancers of the breast, uterus and ovary represent Group II., the female reproductive
system.
The figures illustrating the contrasting incidence by social condition of the
Group I. cancers, inter alia, in the standard (life-table) population of one million
persons over 35 years of age are as follows:—