Overview

Cervical cancer is among the most preventable forms of cancer and primarily affects people assigned to female birth (AFAB) who are under 45 years old.^1,2 The cervix is a part of the uterus that borders the womb and vaginal (birth) canal. During labour, it is the cervix that dilates to allow the delivery of the baby and placenta from the womb.

The uterus is a remarkable organ, but to understand the basics, you could visualise it as an inverted pear, with the cervix representing the narrow end. Two major parts of the cervix – the endocervix and ectocervix – comprise its internal and external regions, respectively.²

The endocervix is the inner part of the cervix that forms a canal leading from the uterus, while the ectocervix is the outer part visible during a gynaecological exam. Most cervical cancers are found at the junction between these two regions.^1,2 Cervical cancer can be treatable, especially when diagnosed early.

Risk factors of cervical cancer include sexually transmitted infections (STIs) and oral contraceptives.^1-4 The inevitability and pervasiveness of these factors contribute, at least in part, to the ubiquitous and challenging nature of cervical cancer. Through this article, we aim to outline those risk factors and empower you to take actionable, preventative steps to reduce your risks of cervical cancer.

Known risk factors

Sexual activity and sexually transmitted infections (STIs) 

It is well known that sexual activity, particularly having several sexual partners, can increase the risk of contracting sexually transmitted infections (STIs), including human papillomavirus (HPV) and human immunodeficiency virus (HIV).^1,2,5 HIV and chronic HPV infections increase the risk of developing cervical cancer, with HPV being the primary contributing factor.^1,2 

Collectively accounting for 70% of HPV cases in the UK, the HPV types most often associated with cervical cancer risk are HPV type 16 and HPV type 18.¹ Both HIV and HPV can be contracted via penetrative and skin-to-skin sexual activity. Additionally, HPV can be contracted orally and through the use of shared adult toys. Unfortunately, there are no treatments for HPV infections, but they typically clear the body naturally within two years. As the name suggests, the suppressive effects of HIV on the body’s immune system can impair your ability to fight HPV infections, thus increasing the risk for cervical cancer.^1,2 

Hormonal contraception

Despite their effectiveness in preventing pregnancy, hormonal contraceptives have been associated with an increased prevalence of cervical cancer, particularly with prolonged use.^2,5 This combination of effectiveness and risk can be undeniably challenging for many women.

Smoking

According to the World Health Organization, the popularity of tobacco use as a lifestyle choice has declined in popularity over the last 20 years. This is a positive change, as smoking has also been linked with increased risk of cervical cancer.² An equally important factor to consider is vaping, which, although it has not yet been linked to cervical cancer, has been associated with decreased fertility, showing its potential impact on the reproductive system.⁶

Family history

Someone with a first-degree relative (i.e. a mother, sister or daughter) who has had a diagnosis of cervical cancer is at increased risk of developing a type of cervical cancer called squamous cell carcinoma (SCC). 

Pregnancy

People who have had one full-term pregnancy are at 15% increased risk of developing cervical cancer compared to those who have had no pregnancies. Likewise, having many full-term pregnancies is associated with an increased risk of HPV and cervical cancers. Speculated reasons behind this include altered hormone and immune factors.¹

Preventative measures

Preventative measures against the risk factors of cervical cancers include, but are not limited to, the following:

• Using barrier contraception: proper use of barrier contraception during sexual intercourse can reduce the risk of contracting HPV
• Regularly getting checked for STIs. You can do this through visiting:
  • Sexual health clinics: find your local NHS sexual health clinic 
  • SH24: A free national STI and sexually transmitted disease (STD) service
• Avoiding oral sexual intercourse: as outlined earlier, HPV is an infection that can be sexually transmitted orally. Avoiding oral sex may therefore reduce your risk

Summary

Cervical cancer is a prevalent gynaecological cancer with several risk factors, and it’s primarily found in the external region of the cervix. Risk factors for cervical cancer include unavoidable factors such as genetics, as well as environmental and lifestyle factors like contraception, STIs, and smoking. Key takeaways include: 

• Cervical cancer primarily affects people assigned female at birth (AFAB) who are under 45 years of age
• It is among the most preventable cancers affecting people assigned female at birth (AFAB)
• One of the leading risk factors for cervical cancer is infection with the human papillomavirus (HPV)

Tools and services for support

• The eve appeal: This is a national charity that focuses on the five internal and external gynaecological cancers affecting the womb, ovaries, cervix, vulva and vagina. It provides tips for ensuring good gynaecological health and funds research into these cancers. Their nurse-provided support service, Ask Eve, allows you to call and speak to nurses about concerns about gynaecological cancers
• Women’s health concern: This charity confidentially supports women on matters of sexual, gynaecological and post-reproductive health. Their website provides quick links and evidence-based resources
• Cancer research UK (CRUK): Frequently recommended by the NHS, CRUK is one of the leading UK cancer charities supporting research into cancer, including cervical cancer, and supports those affected
• Go girls: A UK-based charity supporting women with gynaecological cancers
• Pelvic radiation disease association (PRDA): The PRDA offers post-event support to those at risk of or are living with the unintended consequences of radiotherapy cancer treatment in the pelvic region, known as pelvic radiation disease (PRD)
• Royal college of obstetricians and gynecologists: A vast team of experts that advocates on behalf of women for women’s health issues and trains clinicians in best practice based on updated research
• British gynecological cancer society: A professional home for providers and researchers seeking to improve understanding of gynaecological cancers in the UK