The records of 10,314 Papanicolaou smears were analyzed to determine the incidence of cervical cancer among the rural inhabitants of Holmes County, Ohio. These examinations, obtained from 1950 to 1966, included smears from two populations of women; 3606 were considered typical of rural U.S. populations wheras 2068 were members of a highly chaste and religious group widely known as the Amish. The incidence of cancer of the cervix was considerably lower among Amish women in spite of a higher birth rate and the absence of contraceptives. Socioeconomic a n d medical standards are similar in the two groups b u t the Amish have practiced strict endogamy with monogamous marital behavior for many generations, perhaps limiting the spread of some agent important in the etiology of cervical cancer.
ANY EPIDEMIOLOGIC ASPECTS OF PRIMARY
M cancer of the cervix have resisted satisfactory explanation. Numerous studies (reviewed by LundinQ) have demonstrated differences in incidence among various ethnic, socioeconomic and racial groups. Additional fact0r.s such as circumcision, marital status and dissolution, number of sexual partners, age of marriage and area of residence have been thought to influence the risk of cervical cancer.
The knowledge that the incidence of cervical cancer varies among social groups and is related somehow to marital and coital patterns suggests that significant variation might be found among groups with different culturaIly determined behaviors. T h e present study is an From the