Introduction

Globally, cervical cancer is the fourth most common cancer in women with around 660,000 new cases and around 350,000 deaths in 2022.² The cervix connects the uterus to the vagina. Cervical cancer starts in the cells of the cervix and usually develops slowly over time. Before the cancer develops in the cervix, the cells of the cervix go through abnormal changes. Over time, if not destroyed or removed, these abnormal cells may become cancer cells and grow and spread more deeply into the cervix and to surrounding regions.¹

Studies have shown the undeniable contribution of physical inactivity to cardiovascular disease and other chronic diseases, like diabetes, and cancer. Studies in colon and breast cancer have shown a reduction in the incidence of these cancers with an increase in physical activity. Ongoing research efforts strive to understand the mechanism linking regular physical activity and improvement in the overall quality of life and health status of patients with cancer.³

Understanding cervical cancer

Causes and risk factors

The most common cause of cervical cancer is the Human Papillomavirus (HPV) virus. HPV is a common sexually transmitted infection. It is usually asymptomatic and affects most sexually active people. HPV infections usually go away on their own within two years as the immune system helps fight the infection. However, persistent infection with HPV can cause abnormal cells to develop, which may go on to become cervical cancer. Various risk factors are involved in the progression of the cancer which include:¹ 

1. A weak immune system can decrease the immune system’s ability to fight the HPV infection. HPV infections are more likely to progress to cancer in people who are immunocompromised. Conditions that can lead to immunocompromised states include HIV infection, diseases that weaken the immune system, or taking medications that suppress the immune response, such as those given after organ transplantation, for autoimmune disease, or cancer treatment
2. Smoking: People who smoke or breathe in secondhand smoke have an increased risk of developing cervical cancer
3. Reproductive factors: The use of oral contraceptives and having multiple childbirths are linked to an increased risk of cervical cancer
4. Obesity: Cervical cancer screening may be more challenging in people with obesity, potentially leading to lower detection and a higher risk of cancer

Prevention

Despite the risk factors, cervical cancer is preventable and even curable if caught early. The HPV vaccination and routine cervical cancer screening have been known to prevent almost all cervical cancers.¹

1. A safe and effective way to prevent most types of cervical cancer is the HPV vaccination. The ideal age to get vaccinated is 9–14 years. However, it is to be noted that the HPV vaccine does not treat an existing HPV infection and that the vaccine offers the most protection when given before a person becomes sexually active. Sexually active people may benefit less from the vaccine
2. Cervical cancer screening at regular intervals (after the age of 30) is necessary because HPV vaccination does not protect against all HPV types. For this, the pap smear is the most commonly used test and can detect abnormal cell changes which can then be treated before they turn into cancer
3. The use of condoms to prevent some sexually transmitted diseases can also decrease the risk of HPV transmission. However, they do not completely prevent it

Symptoms

The early stages of cervical cancer do not have symptoms and hence are hard to detect. The symptoms usually begin when the cancer has spread. However, if some symptoms of early-stage cervical cancer do exist, they could include unusual vaginal bleeding after sexual intercourse, after menopause, or between periods, heavier or longer than normal bleeding during periods, pain during sex, and increased or foul smell in vaginal discharge.

In addition to this, advanced cervical cancer symptoms could include pain during bowel movements, during urination, pain in the abdomen, swelling of the legs, and feeling lethargic. Most of these symptoms are not exclusive to cervical cancer and hence to confirm this, it is necessary to see a healthcare professional. Ignoring symptoms could delay treatment making it less effective.¹

Physical activity and cervical cancer 

According to research published in the Journal of Lower Genital Tract Disease, women who do not exercise regularly face an increased risk of developing cervical cancer. The results indicated that women who reported not participating in any physical activity had a 2.5 times higher likelihood of developing cervical cancer compared to those who did engage in physical activity.⁵

Engaging in just 30 mins of aerobic exercise per week can potentially lead to a significant decrease in the risk of a woman developing cervical cancer. Exercise can reduce the risk of cancer for several reasons, including: 

1. It helps maintain a healthy body weight as being overweight is linked to at least 13 different types of cancer
2. It regulates your hormones which can contribute to overall homeostasis
3. It aids in maintaining a healthy digestive system which can reduce the number of toxins in your body
4. It improves the overall quality of life

If you are diagnosed with cervical cancer, taking part in regular physical activity reduces your risk of dying of the disease by 37% and reduces the risk of recurrence by up to 35%. There are many benefits of engaging in physical activity during cancer treatment like:

1. Exercise has been shown to make chemotherapy more effective
2. Engaging in the right type of exercise can help combat fatigue from the treatment
3. Exercise helps maintain cardio-vascular fitness, which is vital to maintain during treatment
4. Maintaining muscle strength and hence returning to everyday life after treatment becomes easier with exercise
5. The risk of swelling in the legs decreases with exercise
6. Low-impact exercises can help relax and hence improve sleep quality which is essential for recovery
7. The benefits of exercise over mental health are well established
8. Maintaining a healthy routine can provide a sense of achievement and self which in turn provides psychological benefits as well

FAQs

How long does it take for the abnormal cervical cells to become cancerous?

Usually, it takes 15 to 20 years for abnormal cells to become cancerous, but in women with weak immune systems, like those with AIDS, this can be faster and take about 5 to 10 years.¹

What is the recommended age for HPV vaccination?

The Centers for Disease Control and Prevention (CDC) has recommended HPV vaccination for girls and boys at around the age of 11 or 12. However, the youngest age that the vaccine can be given is 9. People who were not vaccinated within these recommended age limits can still get vaccination up to age 26. Adults between the ages of 27 and 45 can take the HPV vaccine after talking to their doctor.¹

How many doses are recommended for the HPV vaccine?

The HPV vaccine is usually given in two or three doses, depending on the age at which the vaccination was received. Children who receive the vaccine before they turn 15, receive two doses while people who receive the first dose after 15, and people whose immune systems have been compromised are recommended three doses.¹ 

Do boys also need to be vaccinated?

Some countries have also chosen to vaccinate boys alongside girls to reduce the prevalence of HPV in the general community and to prevent cancers in men caused by HPV.¹

How often should one go for cervical screening?

A cervical screening (smear test) is recommended to be done every 3-5 years.

Summary

In conclusion, cervical cancer is a significant global health concern, but it is largely preventable through HPV vaccination and regular cervical cancer screening. While HPV infection is the primary cause of cervical cancer, various risk factors can increase the likelihood of the infection persisting and progressing to cancer. Adopting a healthy lifestyle can help mitigate some of these risk factors and potentially reduce the risk of developing cervical cancer.

Notably, regular physical activity has been identified as a significant protective factor against cervical cancer. While cervical cancer poses a significant health threat, embracing preventive measures like HPV vaccination, regular screening, and an active lifestyle can substantially reduce the risk of developing this disease. Continued efforts in raising awareness, promoting healthy behaviours, and advancing research could potentially lead to a future where cervical cancer becomes a largely preventable and manageable condition.