Don’t Fear the Pap Smear
What You Should Know About Cervical Cancer
By: Irina Frenkel, Hannah Holmes, and Jennifer
Cancer of the cervix typically originates from a dysplastic or
premalignant lesion that is previously present.
Precursor cells (cervical dysplasia, CIN) develop into invasive
cancer, slowly within several years. CIN grades I,II, and III
correspond to mild, moderate, or severe cervical dysplasia.
The more severe the cervical dysplasia, the more unlikely that it
will regress on it’s own. And if left untreated will become
Squamous cell carcinoma accounts for 80 to 85% of all cervical
cancers. Adenocarcinomas account for most of the rest.
Cervical cancer results from a genital infection called
Human Papillomavirus (HPV), which is a known human
carcinogen. Although HPV infections can be transmitted
via nonsexual routes, the majority result from sexual
To date, more than 115 different genotypes of HPV have
been identified and cloned. A large multinational cervical
cancer study found that more than 90% of all cervical
cancers worldwide are caused by 8 HPV types: 16, 18, 31,
33, 35, 45, 52, and 58. Three types—16, 18, and 45—cause
94% of cervical adenocarcinomas.
Cervical cancer is the third most common gynecologic
malignancy and the eighth most common malignancy
among women in the USA. The mean age for developing
cervical cancer is 50yrs.
Cervical cancer is the third most common malignancy in
women worldwide. Cervical cancer is the second most
common cancer in developing countries, but only the tenth
most common in developed countries.
The American Cancer Society's estimates for cervical
cancer in the United States are for 2013:About 12,340 new
cases of invasive cervical cancer will be diagnosed. About
4,030 women will die from cervical cancer.
Of all the women diagnosed with cancer of the cervix, about 67
out of every 100 (67%) will live for at least 5 years. About 63
women out of every 100 (63%) will live for more than 10 years
after diagnosis. Younger women have a better survival rate than
older women. This is at least partly because in younger women
the disease tends to be diagnosed at an earlier stage.
In the U.S., Hispanic women have the highest rate of cervical
cancer, followed by African Americans, Caucasians, American
Indian/Alaska Natives, and Asian American/Pacific Islanders.
Mortality rates are highest for African American women.
When detected at its earliest stage, cervical cancer has a 5-year
relative survival rate of approximately 91%. For regional disease,
it is nearly 57%. If cancer has spread to distant organs, 5-year
survival drops to approximately 16%.4 In general, the prognosis is
affected by the extent of disease at the time of diagnosis.
Incidence and Mortality
Sexual activity: The main risk factors for HPV infection through sexual activity are early
onset of sexual activity, multiple sexual partners, high-risk sexual partners, and failure
to use a condom.
Smoking: The risk of squamous cell cervical cancer is increased for women who
smoke. Smoking not only exposes the body to cancer-causing chemicals but also
weakens the immune system
Immunosuppression: A weakened immune system, such as that caused by HIV or by
drugs used for suppressing immune response, places women at higher risk for HPV
infection and also for cervical cancer
First full-term pregnancy at a young age: A first full-term pregnancy in women
younger than age 17 nearly doubles the risk of developing cervical cancer later in life,
as compared with women who had their first full-term pregnancy at age 25 and older
Multiple full-term pregnancies: Women with 3 or more full-term pregnancies have an
increased risk of developing cervical cancer. Hormonal changes or weaker immune
systems during pregnancy are possible reasons
Family history: A women with a mother or sister with cervical cancer has 2 to 3 times
the risk of women without this family history
Poverty: Less access to health care
Diet: overweight, may place women at increased risk for developing cervical cancer.
Tobacco prevention and cessation: Smoking cigarettes and breathing in secondhand smoke
increase the risk of cervical cancer. Among women infected with HPV, dysplasia and invasive cancer
occur 2 to 3 times more often in current and former smokers. Secondhand smoke causes a smaller
increase in risk.
Weight control and obesity prevention
Dietary improvements: Diets high in fruits and vegetables may have a protective effect against
many cancers. Conversely, excess consumption of red and preserved meat may be associated with
an increased risk of cervical cancer.
Safer sex: One study found that when condoms are used correctly they can lower the HPV infection
rate in women by about 70% if they are used every time they have sex.
Screening: Vaccination is not a substitute for screening with Pap tests. Even in women who have
been vaccinated, cervical cancer can still occur. Screening is the most effective means for finding
changes in the cervix before cancer has a chance to develop.
HPV Vaccines: Two FDA-approved vaccines (brand names, Gardasil and Cervarix) are highly effective
in preventing infection with the types of HPV they targe
Modifiable Risk Factors
American Cancer Society. Cancer Facts and Figures 2013. Atlanta, Ga: American
Cancer Society; 2013.
Boardman, Celia (2013, July 1). Cervical Cancer. Medscape. Retrieved on October 6,
2013 from http://emedicine.medscape.com
Burda, B.U., Eder, M., Lutz, K., Senger, C.A., Whitlock, E.P., Vesco, K.K. (2011,
October 11) Risk Factors and other Epidemiologic Considerations for Cervical
Cancer Screening. U.S. Preventive Services Task Force. Retrieve on September
30, 2013 from http://uspreventiveservicetaskforce.org
Lacey JV Jr, Swanson CA, Brinton LA, et al. Obesity as a potential risk factor for
adenocarcinomas and squamous cell carcinomas of the uterine cervix. Cancer.
Winer RL, Hughes JP, Feng Q, et al. Condom use and the risk of genital human
papillomavirus infection in young women. N Engl J Med. 2006;354(25):2645-
WHO guide for effective programs (2007, January1). Cancer Control: Knowledge into
Action. Prevention. World Health Organization. Retrieved on October 5, 2013