Effect of smoking cessation on cervical lesion size

Lancet. 1996 Apr 6;347(9006):941-3. doi: 10.1016/s0140-6736(96)91417-8.


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.

Findings: 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.

Interpretation: Our findings support a link between smoking and cervical disease and suggest that smoking cessation could have a beneficial effect on early cervical abnormalities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cervical Intraepithelial Neoplasia / diagnostic imaging
  • Cervical Intraepithelial Neoplasia / etiology
  • Cervical Intraepithelial Neoplasia / pathology*
  • Colposcopy
  • Cotinine / analysis
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Radiography
  • Saliva / chemistry
  • Smoking / adverse effects
  • Smoking Cessation*
  • Social Class
  • Uterine Cervical Neoplasms / diagnostic imaging
  • Uterine Cervical Neoplasms / etiology
  • Uterine Cervical Neoplasms / pathology*


  • Cotinine