Cervical cancer

HPV is the most common viral infection of the reproductive tract. Most HPV infections are asymptomatic and resolve spontaneously, but persistent infection with oncogenic HPV types may lead to cervical intraepithelial neoplasia (CIN), which untreated can progress to invasive cervical cancer.

Cervical cancer is a type of cancer that starts in the cervix, the lower part of the uterus that connects to the vagina. The cervix constantly undergoes changes depending on the menstrual cycle. During these physiological changes, cervical cells can undergo various mutations, favoring the appearance of abnormal (precancerous) cells [1].

Epidemiological studies have shown that the main etiological factor for the development of cervical carcinoma is persistent HPV (Human Papilloma Virus) infection. The types of HPV that favor the appearance of cervical cancer are usually transmitted through sexual contact. HPV infection is spread through contact with infected genital skin, mucous membranes, or bodily fluids, and can be transmitted through sexual intercourse, including oral sex [2].

Not all HPV infections lead to cancer. Most HPV infections are eliminated by themselves, without treatment (70–90% are asymptomatic and resolve spontaneously within 1–2 years). However, persistent HPV infection can lead to the development of cancer over time. Persistent HPV infection is defined by the presence of type-specific HPV DNA on repeated clinical biological samples over a period (usually 6 months) [3].

The interval between the acquisition of HPV infection and progression to invasive carcinoma is usually 15–20 years or longer.

HPV vaccination is an effective way to prevent HPV-related cancers. Regular screening for cervical cancer can also help in the early detection of abnormal cells, which can be treated to prevent the development of cancer.

Risk factors for cervical cancer

The incidence of cervical cancer depends on the prevalence of high-risk types of HPV in the population, along with other factors such as:

Immunosuppression: immunosuppressive therapy, HIV/AIDS infection;
Smoking;
Multiparity: three or more term pregnancies seem to increase the risk of developing cervical cancer. In addition, women whose first term pregnancy occurred before 17 years of age are almost twice as likely to develop cervical cancer compared to women whose first pregnancy occurred at 25 years of age or older;
Consumption of oral contraceptives over long periods of time seems to increase the risk of cervical cancer;
Sexual behavior: early onset of sexual activity, before 18 years; the existence of several sexual partners; the existence of a male partner who has had multiple sexual partners;
Body weight: overweight women have a 25% higher risk of developing cervical cancer, and women with moderate obesity have a 70% higher risk. Also, overweight and obese women have a higher risk of death from cervical cancer;
Hereditary history of cervical cancer: women whose mother or sister had cervical cancer have a 2-3 times higher risk of developing the disease;
History of sexually transmitted diseases (STI, herpesvirus, chlamydia, gonococcal infections);
Poor socio-economic status [4].

Abnormal transformation of the cells of the cervix is asymptomatic, and signs of HPV infection may or may not be present (warts in the oral or genital area). The symptoms of cervical cancer are not always obvious and there may not be any warning sign until the disease has reached an advanced stage. For this reason, it is very important to have regular testing in order to detect certain potentially cancerous lesions and to perform the Pap smear.

References

Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or European Health and Digital Executive Agency (HaDEA). Neither the European Union nor the granting authority can be held responsible for them.