Most women who develop cervical cancer tend to have one or more identifiable factors that increase their risk for the disease. It is uncommon but not impossible for women to develop cervical cancer without any of these risk factors. Some risk factors can be changed (such as smoking and diet) while others cannot be changed (such as age and race). The American Cancer Society suggests focusing on the risk factors that can be changed to help prevent cervical cancer. Though some symptoms can indicate cervical cancer, there are often no symptoms associated with early stages of the disease. Therefore, all women should receive yearly Pap smears once they reach age 18 or become sexually active, whichever occurs earlier. After three negative (normal) Pap smears in three consecutive years, Pap smears may be performed less often at the discretion of the patient’s physician.

• Risk Factors for Cervical Cancer
• Symptoms of Cervical Cancer

Risk Factors for Cervical Cancer

Age: The risk of cervical cancer is highest for women in their late teens through their mid-thirties. Women younger than age 15 rarely develop cervical cancer. Though the risk of cervical cancer does not typically increase after age 40, the risk does not decrease either. Women of all ages, pre-menopausal and post-menopausal, may develop cervical cancer. Therefore, it is important that women continue receiving annual Pap smears as they age.

Race: The American Cancer Society estimates that African-American women are twice as likely to die of cervical cancer than the U.S. national average. Hispanics and American Indians also have higher than average death rates from cervical cancer. Researchers believe these population groups, as well as women with low economic statuses, are less likely to receive annual Pap smears. Pap smears increase the likelihood that cervical cancer will be detected at pre-cancerous or very early cancerous stages when treatment is most successful.

Sexual history: Women who first become sexually active at an early age (before age 16) are at higher than average risk of developing cervical cancer. In addition, women who have had multiple sexual partners are also at higher risk for cervical cancer. This is because these women are at higher risk of contracting the human papillomavirus (HPV), which cannot be prevented by using condoms or other birth control methods. Certain strains of HPV increase cervical cancer risk (see below).

HPV: Certain strains of the human papillomavirus (HPV) increase the risk of cervical cancer. HPV is a common sexually transmitted disease that affects both men and women. There are over 80 different strains of HPV and most do not pose any health risks. However, some strains of HPV (in particular, HPV-16, HPV-18, HPV-31, and HPV-45) can cause cellular changes that may lead to cervical cancer in women. It is estimated that one million new cases of HPV occur each year, and 20% to 40% of sexually active women have some form (usually not harmful) of HPV. Women who have abnormal Pap smear results may be specifically tested for HPV. Click here to learn more about HPV testing.

Smoking: Cigarette smoking may be associated with an increased risk of cervical cancer, as well as other cancers (such as lung). Physicians have found by-products of tobacco in the cervical mucus of women who smoke and believe these by-products damage the DNA of cervical cells, increasing the risk of cervical cancer. Smokers are twice as likely to develop cervical cancer than non-smokers.

HIV: The human immunodeficiency virus (HIV), the virus that causes AIDS, also increases the risk of cervical cancer. This occurs because HIV damages the body’s immune system, making it easier for women to contract HPV, a sexually transmitted disease that may increase the risk of cervical cancer. HIV can also increase the rate in which pre-cancerous cells change into cancerous cells.

DES: Diethylstilbestrol (DES), a hormonal drug prescribed to women at high risk of miscarriages between 1940 and 1971, has been found to increase the risk of cervical cancer in these women’s daughters. This drug is no longer prescribed in the United States. According to the American Cancer Society, approximately 1 in 1000 women (0.1%) whose mothers were given DES during pregnancy develop cervical cancer. The risk is highest in women whose mothers took DES during the first 16 weeks of pregnancy.

Diet: There is some association between diet and increased cervical cancer risk. In particular, diets low in fruits and vegetables may increase the risk of cervical cancer. Increasing one’s intake of micronutrients, such as carotene, vitamins C, and vitamin E may reduce the risk of cervical cancer.

Oral Contraceptives: Studies that have examined the relationship between oral contraceptives and cervical cancer risk have been inconsistent. According to the National Cancer Institute, there is some evidence that long-term use (more than five years) of oral contraceptives may slightly increase the risk of cervical cancer. However, the association between oral contraceptives and cervical cancer risk remains unclear because it is difficult to separate this factor from other risk factors that increase cervical cancer risk (in particular, early age at first sexual intercourse and a history of multiple sexual partners). Because women who use oral contraceptives may or may not have this sexual history, it is difficult for researchers to definitively conclude the role oral contraceptives play in determining cervical cancer risk.

Symptoms of Cervical Cancer

There are often no symptoms with early stages of cervical cancer. Therefore, beginning at age 18 (or when first sexually active), women should receive annual Pap smears to detect pre-cancerous or cancerous cervical cells. The following symptoms may be associated with cervical cancer and should be reported to a physician for further investigation. However, these symptoms can indicate a number of conditions other than cervical cancer.

Symptoms that may be associated with cervical cancer include:

• Unusual vaginal discharge (include spot/light bleeding between menstrual periods)
• Bleeding after sexual intercourse
• Pain during sexual intercourse

Updated: September 19, 2007

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