Cancer of the cervix uteri is the third most common cancer amongst women worldwide with an estimated 569,847 new cases and 311,365 deaths in 2018 (GLOBOCAN). Most cases are squamous cell carcinoma followed by adenocarcinomas (Vaccine 2006, Vol. 24, Suppl 3; Vaccine 2008, Vol. 26, Suppl 10; Vaccine 2012, Vol. 30, Suppl 5; IARC Monographs 2007, Vol. 90).
Worldwide, HPV16 and 18 (the two vaccine-preventable types) contribute to over 70% of all cervical cancer cases, between 41% and 67% of high-grade cervical lesions and 16-32% of low-grade cervical lesions. After HPV16/18, the six most common Human Papillomavirus (HPV) types are the same in all world regions, namely 31, 33, 35, 45, 52 and 58; these account for an additional 20% of cervical cancers worldwide (Clifford, Vaccine 2006;24(S3):26).
Incidence, Risk Factors, and Clinical Presentation
Adenocarcinoma of the cervix and vagina is rare in childhood and adolescence, with fewer than 50 reported cases (McNall, Nowicki, Miller, et al.: Adenocarcinoma of the cervix and vagina in pediatric patients. Paediatric Blood Cancer 43 (3): 289-94, 2004). (You, Dainty, Rose, et al.: Gynaecologic malignancies in women aged less than 25 years. Obstet Gynecol 105 (6): 1405-9, 2005). Two-thirds of the cases are related to exposure to diethylstilbestrol in utero.
The median age at presentation is 15 years, with a range of 7 months to 18 years, and most patients present with vaginal bleeding. Adults with adenocarcinoma of the cervix or vagina will present with stage I or stage II disease 90% of the time. In children and adolescents, there is a high incidence of stage III and stage IV disease (24%). This difference may be explained by the practice of routine pelvic examinations in adults and the hesitancy to perform pelvic exams in children.
The following factors may raise a woman’s risk of developing cervical cancer:
- The most important risk factor for cervical cancer is infection with HPV. HPV is common
- Women with lowered immune systems have a higher risk of developing cervical cancer
- Women who have genital herpes have a higher risk of developing cervical cancer
- Women who smoke are about twice as likely to develop cervical cancer as women who do not
- People younger than 20 years old rarely develop cervical cancer. The risk goes up between the late teens and mid-30s.
- Socioeconomic factors
- Oral contraceptives
- Exposure to diethylstilbestrol (DES)
The prevention and early detection of cervical cancer
The American Cancer Society recommends that individuals with a cervix follow these guidelines to help find cervical cancer early. Following these guidelines can also find pre-cancers, which can be treated to keep cervical cancer from starting. These guidelines do not apply to people who have been diagnosed with cervical cancer or cervical pre-cancer. These women should have follow-up testing and cervical cancer screening as recommended by their healthcare team.
- Cervical cancer testing (screening) should begin at age 25.
- Those aged 25 to 65 should have a primary HPV test* every 5 years. If primary HPV testing is not available, screening may be done with either a co-test that combines an HPV test with a Papanicolaou (Pap) test every 5 years or a Pap test alone every 3 years. (*A primary HPV test is an HPV test that is done by itself for screening. The US Food and Drug Administration has approved certain tests to be primary HPV tests.)
- People who have been vaccinated against HPV should still follow these guidelines for their age groups.