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Cervical cancer risk factors

This page presents risk factors for cervical cancer including, human papillomavirus (HPV), smoking, socioeconomic status and other factors. It is thought that nearly all of cervical cancers are theoretically preventable, by preventing infection with HPV, which is present in all cervical cancers. Smoking also plays a part in causing some cervical cancer, increasing likelihood of infection with HPV or causing HPV infection to be more persistent. A study published in December 2011 estimated that around 7% of cervical cancers in the UK are caused by smoking.36

 

Human papillomavirus (HPV) and cervical cancer risk

Members of the HPV family have been detected in cervical tumours worldwide with studies showing the presence of HPV in virtually all cervical tumours tested.1

The highest risks are associated with HPV types 16 and 18. Most HPV infections will not progress to cervical intraepithelial neoplasia (CIN) . However, it is believed that cervical cancer will not develop without the presence of persistent HPV DNA and it has been proposed as the first ever identified “necessary cause” of a human cancer.2,37

Genital HPV is generally sexually transmitted through contact with infected cervical, vaginal, vulvar, penile or anal epithelium. Genital HPV infection may involve areas that are not easily covered by a condom so correct condom use may not protect against infection.

An analysis of studies on the prevalence of HPV infection in the population led to the conclusions that HPV is more common in younger women than older women, that HPV is rarely detected in women with no previous sexual activity and that there are no apparent geographical differences in HPV prevalence.

The percentage of the study populations who were HPV positive varied from 0% to 48% depending on the group studied. Results also show that HPV 16 infection is more common than any other classified type of HPV.3 Risk factors for HPV infection include number of sexual partners, a relatively recent new sexual relationship and a history of previous miscarriage.4

A study has shown that the main risk factors for CIN 3 among HPV positive women are early age at first intercourse, long duration of the most recent sexual relationship and cigarette smoking.4

For cigarette smoking there is a strong dose-response relationship. The risk of CIN 3 for women who were HPV positive and smoking 20 or more cigarettes a day was two and a half times that of women who had never smoked. The authors concluded that even though smoking was not a risk factor for HPV, smoking acted with HPV to cause cervical neoplasia (see also smoking section below).

Suggested co-factors for cervical cancer include age at first intercourse, number of life-time partners, co-infection with herpes simplex virus-2 or chlamydia trachomatis, parity, age at first birth, oral contraceptive use and family history.5,9,25-28 A lower risk has been shown in partners of men who have been circumcised.29 People diagnosed with genital warts (associated with infection with HPV 6 and HPV 11) have a 50% increased risk of cervical cancer, according to a large cohort study.44

Cervical cancer risk may be further increased in women with other sexually transmitted infections alongside HPV, a cohort study indicates.58

section reviewed 01/12/02
section updated 01/12/02

HPV vaccination

HPV vaccination for schoolgirls aged 12 to 13 in the UK was introduced in September 2008. The programme uses the quadrivalent, Gardasil, vaccine, which prevents against types 6, 11, 16 and 18 (previously, the programme  used Cervarix, which immunises against HPV types 16 and 18). The quadrivalent vaccine was shown in a phase III clinical trial to provide 98% protection against CIN and cervical cancer caused by HPV types 16 and 18, which are the strains of the virus most commonly associated with cervical cancer.32,33 HPV vaccination may also provide protection against CIN caused by other HPV types, and for women with evidence of previous infection with HPV 16 or 18 in blood samples.34,35

section reviewed 10/01/13
section updated 10/01/13

 

Tobacco

Tobacco smoking is classified by IARC as a cause of cervical cancer.52 An estimated 7% of cervical cancers in the UK are linked to smoking.53 This association is independent of HPV infection, however smoking may inhibit immune response to HPV infection, and/or cause DNA damage in HPV-infected cells.54

Cervical cancer risk is twice as high in HPV-positive women who smoke, compared with those who do not smoke, pooled analyses and a large cohort study have shown.55-57 This increased risk may be restricted to squamous cell carcinomas.[ref 30] Risk of CIN3/CIS is twice as high in smokers compared with non-smokers, a large cohort study showed.57

Cervical cancer risk is lower in former smokers compared with current smokers, pooled analyses and a large cohort study have shown.55-57

section reviewed 04/04/14
section updated 04/04/14

 

Socio-economic status and cervical cancer risk

In England and Wales,12 incidence and mortality from cervical cancer has been analysed by to Carstairs deprivation category (Figure 4.1).

Figure 4.1: European age-standardised incidence of and mortality,cervical cancer by deprivation category, England and Wales, 1990-93

Download this chart (27KB)

Women living in the most deprived areas have rates more than three times as high as those in the least deprived areas. A strong positive association between cervical cancer and deprivation has also been described for incidence data from Scotland.13

In addition a link has been demonstrated between social class and cervical cancer. Data from a longitudinal study, representing 1% of the England and Wales population, indicates that cervical cancer incidence is considerably higher among women of working age in manual than in non-manual classes.14

section reviewed 01/12/02
section updated 01/12/02

Immunosuppression

The International Agency for Research on Cancer (IARC) states that HIV is a cause of cervical cancer.43 Cervical cancer risk is sixfold higher in women with HIV/AIDS compared with the general population, a meta-analysis showed.22 Among women with HIV, cervical cancer risk may be reduced by treatment with highly active antiretroviral therapy (HAART), but evidence remains unclear.45-48

Cervical cancer risk is not increased in organ transplant recipients compared with the general population, US data have shown, perhaps due to effective cervical screening in this population.49,50 Though CIN3 risk was increased in transplant recipients in a Swedish cohort study, risk of invasive cervical cancer was increased only in kidney recipients.51 A meta-analysis showed organ transplant recipients have double the general population risk of cervical cancer.22

section reviewed 28/02/14
section updated 28/02/14

Other cervical cancer risk factors

As with smoking, the association between oral contraceptive (OC) use and cervical cancer is complicated by possible confounding with sexual behaviour.15 A meta-analysis found risk of invasive cervical cancer in current users of combined OCs increases by 7% for each year of use. The risk increase for five years of use is approximately 40%. The risk increase is temporary, and risk returns to the level of a never-user after 10 years of stopping use.17

A study published in December 2011 estimated that around 10% of cervical cancers in 2010 were linked to OCs. However, when the protective effect of OCs on ovarian and womb cancer were taken into account, OCs were estimated to have a net beneficial effect, reducing the number of cancers in women in the UK by almost 1,600.39

Other studies20, 21 have investigated the use of hormone replacement therapy and cervical cancer, but there are no clear conclusions.

A recent meta-analysis showed that women with HIV/AIDS have a six-fold increased risk of cervical cancer and women who have undergone organ transplant have more than double the risk, strongly suggesting that immunosuppression plays a role.22 The International Agency for Research on Cancer (IARC) states that HIV is a cause of cervical cancer.43

It has been estimated that around 1% of cervical cancers in women in the UK are linked to occupation.40,42 This estimate was based on exposure to tetrachloroethylene, which is classified by IARC as probably carcinogenic to humans.42,43 Exposure can take place in dry cleaning and metal degreasing.41

Diethylstilboestrol (DES) is a drug that was given to some women in the 1940s-60s to prevent miscarriage. IARC states that exposure to DES in the womb is a cause of cervical cancer.43

Risk of cervical cancer is almost twice as high in women whose sister or mother has been diagnosed with the disease, but cervical cancer is not hereditary. Rather, close relatives may have similar lifestyles which influence their risk of cervical cancer (for example sexual behaviour or smoking), and/or they may have shared genetic factors (for example affecting immune response to HPV infection).31

section reviewed 01/12/02
section updated 01/12/02

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References for cervical cancer risk factors

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Updated: 9 January 2012