Monday 20 January marks the start of Cervical Cancer Prevention Week – an annual event established to raise awareness about cervical cancer and the importance of early detection, vaccination, and screening in saving lives.
Among women, cervical cancer is the fourth most common cancer and, staggeringly, around 90% of the deaths from cervical cancer occur in low- to middle-income countries [1]. During the past 25 years, the incidence and death rate of the disease have decreased; and further promising statistics are that when cervical cancer is diagnosed at an early stage, the 5-year relative survival rate is 91%. However, the 5-year survival rate of patients when cervical cancer is diagnosed after it has spread to nearby tissues, organs, or lymph nodes drops to 60% [2]
In its early stages, cervical cancer often doesn’t have symptoms, which makes it hard to detect [2]. Therefore, to help ensure all women and people with a cervix know how cervical cancer can be prevented, in this article we look at the measures that can be taken to aid early detection and reduce the risk and burden of the disease.
Know the Risk Factors
Almost all cases of cervical cancer are caused by Human Papillomavirus (HPV). This is a very common virus, and nearly all people who are sexually active will become infected with HPV at some point in their lives [3]. There are at least 14 strains of the virus which are known to cause cancer, and two specific types – HPV-16 and HPV-18 – cause 70% of cervical cancers and 40%–60% of precancerous cervical lesions [3, 4].
In most cases, the body’s immune system will clear an HPV infection on its own [1]. However, there are some risk factors that will make it more likely for a person who has a high-risk HPV infection of the cervix to develop cervical cancer. These risk factors include:
Having a weakened immune system. Having a weakened immune system can lower the body’s ability to fight an HPV infection. A person may be immunocompromised if they:
- have an HIV infection or another disease that weakens their immune system
- take medicine to suppress their immune response, for example; to prevent organ rejection after a transplant, to treat an autoimmune disease, or to treat cancer
Smoking or breathing in second-hand smoke. People who breathe cigarette smoke have an increased risk of developing cervical cancer.
Reproductive factors. The use of oral contraceptives and giving birth to many children are both associated with an increased risk of cervical cancer. The reasons for these associations are not well understood.
Obesity. As cervical cancer screening may be more difficult in those people with obesity, which may lead to lower detection of precancers, resulting in an increased risk of cancer. [5]
Important Preventive Measures
HPV vaccines are available for boys and girls
There are currently two vaccines with high efficacy that protect individuals against infection and precancerous cervical lesions caused by HPV-16 and HPV-18 [4]. Since 2008, girls aged 11 years and over in Scotland and girls aged 12 years and over in the rest of the UK are eligible to receive an HPV vaccine [5]. In addition, it has been shown that the vaccines could also protect boys from other HPV-related cancers and promote ‘herd immunity’ among children who have not been vaccinated. For this reason, since September 2019, boys aged 12 years and over have also been eligible to receive the HPV vaccine in the UK [5, 6].
Cervical screening
In the UK, women aged 25–49 years are entitled to attend free cervical screening appointments (also known as ‘smear tests’) every 3 years; the intervals are then reduced to every 5 years for women aged 50–64 years [7]. The purpose of cervical screening is to prevent cervical cancer by looking for the presence of high-risk HPV strains and to check the cervix for any abnormal cells. [7].
During cervical screening, a small sample of cells is taken from a woman’s cervix and then tested for high-risk HPV strains [7, 8]. If there are none present, no further tests are required until the next routine cervical screening [8]. However, if any high-risk HPV strains are found, the sample will be further analysed to identify any changes in the cells of the cervix; this can allow precancerous lesions to be treated before the condition evolves into cervical cancer [8].
Cervical screening only takes a few minutes and is an extremely valuable opportunity to detect and treat any abnormalities before they potentially develop into cervical cancer
Awareness of the initial symptoms
Awareness of the symptoms of cervical cancer can aid early detection of the disease. Symptoms may include:
- Unusual bleeding is usually the first noticeable symptom of cervical cancer [9]. This includes bleeding during or after sex, between periods or after the menopause [9].
- Pain and discomfort during sex
- Unusual or unpleasant vaginal discharge
- Pain in the lower back or pelvis [9].
If any of the above symptoms are experienced, medical advice should be sought immediately.
How we can protect ourselves and others
According to Cancer Research UK, 99.8% of cervical cancer cases are preventable [10]. There are simple measures that everyone can take to reduce their risk of HPV-related cancers:
1.Attend your free cervical screening appointment when provided with the opportunity to do so.
2. Get vaccinated. If you did not receive the vaccine during your school years, you are eligible to receive the vaccine for free up until the age of 25 years (this applies to men and women).
3. Be aware of the symptoms. If you experience any of the symptoms above, seek medical advice immediately.
4. Avoid unprotected sex.[4] Condoms may help decrease the risk of HPV transmission.
5. Raise awareness of the disease and the important preventive measures for cervical cancer.
6. Know where to find support and further information. If you need further support, please speak to your GP or visit: https://www.gov.uk/government/publications/cervical-screening-support-for-people-who-find-it-hard-to-attend/cervical-screening-support-for-people-who-feel-anxious-about-attending
References
1. World Health Organization. Human papillomavirus (HPV) and cervical cancer. Available at: https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer. Accessed January 2025.
2.National Cancer Institute. Cervical Cancer Symptoms. Available at: https://www.cancer.gov/types/cervical/symptoms. Accessed January 2025
3. National Cancer Institute. Cancer Stat Facts: Cervical Cancer Prognosis and Survival Rates. Available at: https://www.cancer.gov/types/cervical/survival. Accessed January 2025
4. National Cancer Institute. Cervical Cancer Causes, Risk Factors, and Prevention. Available at: https://www.cancer.gov/types/cervical/causes-risk-prevention.
5. Arbyn M, Weiderpass E, Bruni L et al. Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis. Lancet Glob Health 2020; 8 (2): e191–e203.
6. Gov.UK. Health and social care. Public health. Health protection Immunisation. HPV universal vaccination: leaflet. Available at: https://www.gov.uk/government/publications/hpv-vaccine-vaccination-guide-leaflet/information-on-the-hpv-vaccination-from-september-2023 Accessed January 2025.
7. HPV Action: Jabs for the Boys. Jabs For The Boys: Let’s beat HPV. Available at: http://jabsfortheboys.uk/. Accessed January 2025.
8. National Health Service. Overview: Cervical cancer. Available at: https://www.nhs.uk/conditions/cervical-cancer/. Accessed January 2025
9. National Health Service. Symptoms: Cervical cancer. Available at: https://www.nhs.uk/conditions/cervical-cancer/symptoms/. Accessed January 2025.
10. Cancer Research UK. Cervical cancer statistics. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer. Accessed January 2025.
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