Advanced Cervical Cancer
Who is at risk of getting cervical cancer?
Persistent/chronic HPV infection is the most commonly reported cause of cervical cancer.
There are a few known risk factors of cervical cancer. However, all women who are exposed to one or more of them do not necessarily develop the disease. In fact, only a minority of them do. And, it is still not well understood, why. Whatever the risk factor is, cervical cancer first develops as pre-cancerous lesions, which can be detected with the help of screening tools. The known risk factors are:
I. Human papillomavirus (HPV) infection
Infection by “high-risk” human papillomavirus (HPV) is reported is the predominant cause of cervical cancer4. HPV infection is generally common and in most, the body itself clears the infection on its own.
Human papilloma virus (HPV) & Cervical cancer
- ‘HPV’ is a common virus and forms a group of more than 150 related viruses. Among these, the “high-risk” sub-type of HPV can cause cervical cancer. There are 15 high-risk HPV sub-types, with just two, HPV 16 & 18, responsible for 70% of all cervical cancers.
- HPV is spread mainly by skin-to-skin contact, for example, during sexual contact. It can spread even when an infected person does not show any symptoms.
- In most people, body itself clears the HPV infection on its own. In some case however, infection persists, resulting in pre-cancerous lesions, which may lead to cancer.
- While an HPV test can help detect HPV virus, a Pap test is used to test for abnormal cellular changes in the cervix. These, and other cervical cancer screening methods are proven tools to keep risk of cervical cancer at bay.
II. Other risk factors
i. Sexual activity
Early onset of sexual activity, multiple partners, high-risk sexual partners and failure to use condoms may increase the risk of HPV infection – the predominant cause for cervical cancer.
Whether active or passive, smoking increases the risk of cervical cancer.
iii. A weakened immune system
A weak immune system due to infections such as HIV or by drugs causing suppression of immune system can place women at high risk.
iv. Teenage pregnancy & Multiple pregnancies
First pregnancy at age below 17 years, doubles the risk of cervical cancer at a later stage of life than in women who wait till age 25 to get pregnant. Also, women who have had more than 3 full-term pregnancies are at a higher risk of developing cervical cancer, possibly due to hormonal changes and being subject to weaker immune system during the pregnancy term.
v. Economic status
Low income group women may be at higher risk of developing cervical cancer, purely because they might not have access to health services for proper and regular screening for cervical cancer.
vi. Diethylstilbersterol (DES)
Diethylstibersterol (DES) is a hormonal drug which was administered in women during 1940-71 to prevent miscarriage, but was later withdrawn. Females whose mothers might have taken DES when pregnant, are at a higher risk of developing cervical cancer.
AJCC: American Joint Committee on Cancer CC: Cervical cancer DES: Diethylstilbersterol DNA: Deoxyribonucleic acid FIGO: International Federation of Gynecology and Obstetrics HPV: human papillomavirus Pap test: Papanicolaou test TNM: Tumor, node, metastasis staging system VEGF: Vascular Endothelial Growth Factor
- Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68(6), 394-424. doi:10.3322/caac.21492
- Source: What is cervical cancer?, American Cancer Society, Available at: https://www.cancer.org/cancer/cervical-cancer/about/what-is-cervical-cancer.html, Accessed on 01.02.2019
- Walboomers, J. M., Jacobs, M. V., Manos, M. M., Bosch, F. X., Kummer, J. A., Shah, K. V., … Muñoz, N. (1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. The Journal of Pathology, 189(1), 12-19. doi:10.1002/(sici)1096-9896(199909)189:1<12::aid-path431>3.0.co;2-f
- Carcinoma of the cervix and tobacco smoking: Collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. (2005). International Journal of Cancer, 118(6), 1481-1495. doi:10.1002/ijc.21493
- HPV Vaccines: Vaccinating Your Preteen or Teen, Centers for Disease Control and Prevention, Available at: https://www.cdc.gov/hpv/parents/vaccine.html, Accessed on 27.02.2019
- The Pap Test, American Cancer Society, Available at: https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/pap-test.html Accessed on 14.02.2019
- The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer, American Cancer Society, Available at: https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html Accessed on 14.02.2019
- The HPV DNA test, American Cancer Society, Available at: https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/hpv-test.html Accessed on 14.02.2019
- Treating cervical cancer, American Cancer Society, Available at: https://www.cancer.org/cancer/cervical-cancer/treating.html Accessed on 15.02.2019