Cervical cancer starts in the cells of the cervix, the lower part of the uterus (womb) that connects to the vagina (birth canal). The primary cause is a long-lasting infection with high-risk types of human papillomavirus (HPV), the most common sexually transmitted infection (STI).
While not all HPV infections lead to cancer, persistent infections can cause cell changes that may develop into cancer over time. Regular pap smears and HPV screenings are crucial for detecting these changes early, along with HPV vaccination. Factors like smoking, sexual activity, and a weakened immune system can also increase the risk of cervical cancer.
Human Papillomavirus : is a group of over 200 viruses, most of which spread through sexual contact. While most HPV infections resolve on their own, some can cause complications. Low-risk types, like HPV 6 and 11, can cause genital warts (an STI that causes small, raised bumps on or near your genitals and anus). High-risk types, such as HPV 16 and 18, can lead to cervical cancer. There's no cure for HPV, but the vaccine can significantly lower your risk. Even with the vaccine, it's important to keep up with screenings, including pap smears and HPV testing, because the vaccine doesn’t protect against all types of HPV. You might also experience exposure to HPV before vaccination.
Is Cervical Cancer Hereditary? Nearly all cases of cervical cancer are due to HPV, with only 0.3% resulting from rare causes. Parents generally don’t pass cervical cancer directly to their children, but some rare genetic conditions can increase the risk of these less common types.
For example: Peutz-Jeghers syndrome raises the risk of a rare form of cervical cancer due to a mutation in the STK11 gene. This gene helps make an enzyme that suppresses tumor growth.
Lynch syndrome increases the risk of cervical cancer by 5.6 times due to mutations is MMR genes that repair DNA.
Families might also have genetic traits that make it harder to protect against HPV. For instance, variations in MHC genes, which help the immune system fight infections, or the p53 gene, which controls cell growth and death, can affect how the body responds to HPV.
Who Gets Cervical Cancer? While anyone with a cervix can develop cervical cancer, certain factors can increase this risk. Age: Cervical cancer is more common in people over 35. Although HPV infections often occur in those between 18 and 30, it usually takes years for the infection to progress to cancer.
Sex: Most people assigned female at birth have a cervix unless a health condition or treatment affects it or they have surgery to remove it.
Ethnicity: Hispanic and Black populations have higher rates of cervical cancer and later-stage diagnosis compared to non-Hispanic white populations, but it's nuanced. Emerging data points to insurance status as a mediating risk factor. In other words, it might be systemic racism rather than ethnicity itself causing different patterns of care for different ethnicities.
Rural area: People living in rural areas have higher rates of cervical cancer than those in urban areas.
Developing countries: High-risk HPV infections affect about 10% of females worldwide. However, it can affect up to 36.5% of those in developing countries.
Risk Factors
Several risk factors can increase your risk of getting cervical cancer, but having them doesn’t guarantee you’ll get the disease. Focusing on factors you can change and keeping up with regular screenings is important for catching and treating cervical changes early.
Multiple HPV Types and Frequency of Infections :Persistent infection with high-risk types of HPV is the primary cause of cervical cancer. When these high-risk HPVs infect the cervix, they can cause changes in the cells that may become cancerous over time.
Having multiple HPV types or frequent HPV infections can also make it more difficult for your body to get rid of the virus. Smoking : People who smoke are about twice as likely to get cervical cancer than those who don’t smoke. Chemicals in tobacco smoke can harm DNA in cervical cells and make it harder for the immune system to fight HPV infections.
Sexual History: Certain aspects of sexual history can make you more likely to get cervical cancer because they increase your chances of getting HPV. These include: Starting sexual activity at a young age, especially before 18, Having many sexual partners, Being with a partner who has HPV or who has had many sexual partners, Getting the HPV vaccine before you start having sex can help reduce risk. Other Sexually Transmitted Infections (STIs) Having other sexually transmitted infections (STIs), like genital warts or chlamydia, can increase the risk of cervical cancer. Chlamydia is a bacterial infection that spreads through sexual contact. It can cause inflammation (swelling) of the reproductive organs. It may also make HPV stay in the cervix longer, increasing the risk of cancer developing.
A Weakened Immune System Conditions like human immunodeficiency virus (HIV) and certain medications can weaken your immune system. For example, you might need immune-suppressing medications after an organ transplant or to treat cancer or autoimmune diseases (when your body mistakenly attacks healthy cells). This can increase your risk of cervical cancer because it lowers your body’s ability to fight HPV infections.
Hormonal changes, like puberty and your first pregnancy, cause cervix cells to change quickly, making them more susceptible to infection. Having three or more full-term pregnancies or having your first one before age 20 can also raise the risk. This may be due to higher HPV exposure or hormonal changes that damage DNA in cervical cells.
The risk typically lowers after menopause when female reproductive hormones decrease.
Hormonal Contraceptives (Birth Control) Long-term use of hormonal birth control may increase the risk of serious cervical disease. This is because high-risk HPV can react to hormones like progesterone, making it easier for the virus to cause problems. The risk returns to normal after stopping the medication.
Diethylstilbestrol (DES)
Diethylstilbestrol (DES) was a drug given to some pregnant people between 1938 and 1971 to prevent miscarriage. People whose mothers took DES might have a small risk of developing a rare type of cancer in the vagina or cervix. However, this type of cancer is very rare, and 99.9% of these people do not get the cancer.
Barriers To Cervical Cancer Screening and Treatment
Barriers to screening and treatment can increase your risk and lead to later diagnoses. For example: If you live in a rural area, you might face fewer healthcare options and long travel distances.
Lower socioeconomic status or lack of health insurance can limit access to screenings and vaccines.
Cultural beliefs, language barriers, and past negative experiences with healthcare can also make it harder to get the care you need.
In Summary: Cervical cancer mainly occurs because of a long-term infection with high-risk types of HPV. Not all HPV infections cause cancer, but some can change cervical cells and lead to cancer over time. Regular pap smears and HPV tests help catch these changes early, and getting the HPV vaccine can lower your risk.
Smoking, your sexual history, hormone changes, and a weak immune system can also increase your risk. Living in a rural area, having a lower socioeconomic status, not having health insurance, and facing cultural barriers can also make it more difficult to get the screenings and treatment you need, which can lead to more serious problems later.
As always be Safe, Stay Healthy and be Careful out there
James A Vito, D.M.D.