Cervical Cancer

The cervix is the entrance to the womb from the vagina. Cervical cancer is a significant public health concern. Worldwide, there were 570,000 new cases and 311,000 deaths from cervical cancer in 2018. However, cervical cancer is a largely preventable disease and there are some measures that you can take to further reduce the risks to your health from cervical cancer.

Find out more about the causes, symptoms, and preventative measures that you can take against cervical cancer in this article.

What causes cervical cancer?

Cervical cancer is most commonly caused by some strains of the Human Papillomavirus (HPV). There are over 100 known strains of this virus, at least fourteen of which are cancer-related. Two strains of HPV are considered high-risk as they account for over 70% of cases of cervical cancer: these are HPV 16 and HPV 18. Having the virus does not necessarily mean that you will develop cervical cancer. In fact, studies say that HPV can be found in most sexually active men and women at some point during their lives. Most of the time, the immune system fights off the infection before the virus causes any harm.

However, your risk of developing cervical cancer after contracting HPV is increased by some risk factors. These factors include:

Young age at first intercourse
Multiple sexual partners
Smoking
Suppression of the immune system: for instance, due to HIV infection
Oral contraceptive use for more than 5 years
Coinfections (e.g. chlamydia, gonorrhoea, herpes simplex)
Parity (number of babies born) and young age at first birth

HPV is transmitted from person to person by skin to skin contact during sexual intercourse, touching of the genitals by hands, and vaginal, oral or anal sex. Additionally, HPV is associated with other diseases, including:

Genital and skin warts (growths or skin changes)
Vaginal, vulval, penile, anal, and oropharyngeal (throat and mouth) cancers
Some cancers of the head and neck
Laryngeal papillomas (warts on the voice box and vocal cords)

What are the symptoms of cervical cancer?

In the early stages, people with cervical cancer show no symptoms at all. Some symptoms to look out for include:

Pain or bleeding during sexual intercourse
Irregular blood spotting or light bleeding between periods/postmenopausal spotting or bleeding
Increased vaginal discharge, which may smell bad

See a doctor if you experience any of the symptoms above. A doctor may then ask you whether you have been exposed to the risk factors listed above, any symptoms you may have had, and then examine you.

How can I minimise the risk of developing cervical cancer?

There are two main preventative measures that women can take to minimise the risk of developing cervical cancer: the Human Papillomavirus (HPV) vaccine and the cervical screening test (previously known as smear tests). It is important to undergo both the vaccine and screening if you are eligible.

The HPV vaccine

Children aged twelve to thirteen years old (school year eight) are offered HPV vaccination as part of the NHS childhood vaccination programme.the HPV vaccination as part of the NHS childhood vaccination programme. The HPV vaccine is given as a series of two injections spaced at least two months apart. People who get their first vaccination dose at the age of fifteen or older will need to have three doses. Anyone who missed their HPV vaccination in school Year eight can get the vaccine for free on the NHS up until their 25th birthday.

The vaccine notably protects against strains HPV 16 and HPV 18. These two strains of viruses that carry the highest risk of developing cervical cancer. Studies show that the HPV vaccine offers protection for at least ten years, though experts believe that the effects last longer than that in most people. It is estimated that around 400 lives could be saved every year as a result of the national HPV vaccination programme.

The cervical screening test (smear test)

The cervical screening test is a way of identifying abnormal cells in the cervix before they progress to become cancerous. Removal of these abnormal cells can therefore prevent cervical cancer. If your screening tests are positive, you will be referred for further tests such as a colposcopy (a procedure to look at your cervix) and a biopsy (a process which samples and examines cells under microscope.

The table below summarises the population groups that need to undergo the cervical screening test:

Group	How often?	Reason
Women under 25 years	None	Abnormal cells in the cervix are common and do not normally lead to cancer. Regular testing will result in a large proportion of “false positives”, where the cells are found to be abnormal but do not lead to cancer
Women between 25 and 49 years	Every three years	This population group is at the highest risk of developing cervical cancer, which means that more frequent screening is required
Women between 49 and 64 years	Every five years	This population has a lower risk of developing cervical cancer compared to women aged 25-49
Women aged 65 years and over	None, except women who had never been screened or had not been screened since the age of 50 and women for whom one of the last three tests was abnormal	This population has an even lower risk of developing cervical cancer compared to women aged 49-64. Only women who are identified as high risk in this age group will be screened

Avoiding infection with HPV

In addition to attending screenings and getting vaccinated, we recommend that you lower your risk of cervical cancer caused by HPV by taking precautions to avoid getting infected.

Using a condom every time you have vaginal, oral or anal sex reduces your risk of catching HPV. However, HPV is transmitted via skin contact and you can still catch it when using a condom. Additionally, you can make lifestyle changes such as stopping smoking.