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Cervical Cancer

Ideas about causes of cervical cancer

The main risk for getting cervical cancer is persistent infection with some types of human pailloma virus known as High Risk HPV. This is a sexually transmitted virus but is extremely common. Anyone who has ever had sex is likely to have been infected. However, most people will clear up the virus with their own immune system within 2 years.

The risk of getting HPV increases with the number of sexual partners and with starting to have sex at an early age. The risk of having a persistent infection is related to a weakened immune system. Smoking can impair the immune system of the cervix and as such is a risk factor for cervical cancer. Infection with HIV also reduces immunity and increases the risk of cervical cancer. Women who have had an organ transplant have to take drugs to suppress their immune system so that they do not reject the donor organ and this also increases the risk of cervical cancer. It is important that all women go for regular cervical screening to help protect against cervical cancer.

Many of the women we interviewed were aware of some of the risk factors associated with cervical cancer and said these risk factors were not present in their own lifestyle. Many believed it could happen to anybody and felt that they were just unlucky.

 

She couldn't identify any known cause for why she developed cervical cancer.

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Age at interview: 36
Sex: Female
Age at diagnosis: 27
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Yes, obviously in the beginning when the doctor are talking to you they ask you if you've had any cancer in your family which, there wasn't anything. They'd asked me if I'd had lots of sexual partners, which I hadn't. They'd asked me if I'd started having sexual intercourse early, which I didn't. They'd asked me about my diet, which I thought was quite normal. They'd asked if I'd had anything stressful things in my life which I couldn't actually pinpoint anything. So for me I didn't feel there was a real, there was a real cause, I'm just a statistic I'm afraid. I don't know why I really don't and if I could have said one of those things, there wasn't anything really.

One of the things they talk about as well, perhaps more recently, is smoking, have you heard about that?

I haven't no, I've never smoked, never.

 

She stresses that anybody can get cervical cancer.

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Age at interview: 37
Sex: Female
Age at diagnosis: 32
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And I don't deny if somebody says, if they ask questions about cancer, I don't tell them it was some other cancer. I don't feel unable to say it. And in fact I feel quite the other way round, I want to tell people that it can happen to quite normal people. I think Edwina Currie had sort of , linked it to that perhaps if people didn't smoke, didn't sleep around then they wouldn't sort of get these things. And I wanted to almost counteract that by saying I've been in a monogamous relationship since the age of 19, I'm still with the guy, we have a very normal sexual life and it can happen to anybody, if you have one partner it can happen to you.

A few felt that some of the risk factors may have been present in their own lifestyle, such as HPV, smoking and long term use of the contraceptive pill. Some questioned whether they had developed HPV many years ago and were unaware of it. Others questioned whether their husbands or partners could have given them HPV. A few were not aware that HPV or smoking can be a risk factor for cervical cancer. Since there are no symptoms for HPV, most people don’t even know they have contracted the virus.

 

She questions whether she had contracted the human papilloma virus many years before she...

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Age at interview: 41
Sex: Female
Age at diagnosis: 39
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Well yeah, I mean I went through all this again from the information that I read at the beginning and my consultant. And the most common I've been told is the HP virus, the wart virus and being told, well I've asked, I said 'Do you know what caused my cancer? Now you know you've seen it and now I've been operated on, can you tell the cause?' And I've been told 'No.' Which, from what I've read about it I was really surprised because I'd only been with one man, I only had one sexual partner in years and I said 'Well why has this happened now? If that was the cause of it then why didn't it happen fifteen years ago when I met my current partner you know, what's happened?' And he did tell me it can lay dormant and then anything can have an effect on cells that might make them transform from quite an innocent virus into something more aggressive. But I mean whether it was that, I don't know and he didn't really dwell on any other causes.

Recent medical evidence suggests that some types of HPV, which is a sexually transmitted virus, are a major risk factor for cervical cancer. HPV is thought to cause 99.7% of cervical cancers*1.

There are more than 100 different types of HPV, many of which are harmless. The types of HPV that can cause warts, genital warts and verrucas are known as ‘low risk’ strains and do not usually cause cell changes or develop into cancer.

​"However, some types of HPV can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer” (NHS Choices website 2017). These types of HPV can cause changes in the cells of the cervix or the lining of the mouth and throat. They are known as high risk HPVs. The changed cells have an increased risk of becoming cancerous.

It is thought that 15 strains of high-risk HPV’s are responsible for causing cervical cancers *2 and “two strains of the HPV virus (HPV 16 and HPV 18) are known to be responsible for 70% of all cases of cervical cancer. (NHS Choices website 2017)

Nearly all sexually-active men and women get HPV at some point in their lives - 80% (four out of five) of the world’s population will contract some type of the virus once*3. HPV is transmitted primarily by genital-to-genital sexual contact, anal sex and, occasionally, oral sex. It can also be transmitted from same-sex partner to same-sex partner. Infection with HPV does not imply either infidelity or promiscuity as even people who have sex with only one person in their lifetime can get it.

Most women who have the virus do not develop cervical cancer. However, a small number of women do develop abnormal cells that may become cancerous. This is why cervical screening and HPV vaccination is important in helping to prevent cancer.

Since April 2011, the NHS Cervical Screening Programme has been introducing a new testing system called the ‘HPV triage’ so if a woman has a screening result that shows abnormal cell changes the sample is automatically tested for the HPV virus.

• If HPV is found (an ‘HPV positive’ result), you are invited to go for colposcopy, which is a closer look at the cervix to see if any treatment is needed.
• If no HPV is found, you can go back to regular screening every 3-5 years depending on your age (NHS Cervical Screening Programme April 2015)

Some women found that it was difficult to deal with having a cancer which had sexual connotations associated with it.

 

Having a cancer which has sexual connotations can be difficult to deal with.

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Age at interview: 49
Sex: Female
Age at diagnosis: 41
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The other thing with cervical cancer is sexual connotations and that's very difficult to deal with because there are theories you've been a bad person basically which I'm not sure how medically that pans out these days. There's various theories on people who are more prone to cervical cancer anyway. One thing, again I wish I'd known more about about at the time is that I had HPV for a long time and there was never any connection made when I was treated for that, that I should have more regular smear tests and now I think you would do which would pick it up earlier. So that's something that's progressed on since then. There wasn't the connection at the time at all I don't think.

 I think medical opinion differs anyway, I mean I don't think anyone can say it's a direct causal relationship or anything. It's just one of the factors that seems to be involved when people have cervical cancer. And I think the important thing that came out with talking to people is that people shouldn't blame themselves. Nobody really understands cancer otherwise they'd be able to cure it wouldn't they?. So there's no point blaming yourself. It's very difficult with that sort of cancer in particular in some ways because other sorts of cancers. I suppose you could blame yourself for eating the wrong food or something like that, there again if anybody wants to blame themselves I suppose they will, but there's more connotations with cervical cancer in a way I think that makes it harder for people I think.
 

She discusses the negative connotations associated with cervical cancer.

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Age at interview: 53
Sex: Female
Age at diagnosis: 51
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I read, when I had the dodgy smear and I had the colposcopy I got a book about it and some of the things that they said were starting sex life at a very early age. These are possible causes, having more than one sexual partner, I forget what the other things were. 

I suspect most women in the last sort of 30 or 40 years, may be not 40 but the last 30 years, there aren't that many women who meet the person they are going to spend the rest of their life with and spend the rest of their life with one person. There are some of course but I wouldn't advocate sort of blatant promiscuity but I had a broken marriage I've had a few different relationships and I wouldn't see myself as being wildly promiscuous when I was young but nor was I a little nun either. So I don't blame myself for that, I don't sort of sit and think, because I think that's a bit futile really isn't it, what's the point me sitting around thinking oh if only I'd done this, if only I'd done that. 

And so I think that some of the information that's going round about the causes of cervical cancer is actually causing people to think well you only get cervical cancer if you're wildly promiscuous and started having sex when you were sort of 15 or 16 years old and of course that's wrong. I think that there may be are some misconceptions.

Some women were aware of the link between smoking and cervical cancer but many said they had never smoked. One woman explains how she was not aware that smoking was a risk factor for cervical cancer when she was diagnosed ten years ago. Most of the women who did smoke, gave up when they were told they had cervical cancer.

 

She wasn't aware that smoking is a risk factor for cervical cancer when she was diagnosed ten...

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Age at interview: 46
Sex: Female
Age at diagnosis: 36
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The interesting thing that I found was that one of the things that I can remember saying when I went for one of the consultations, I can't remember which one, was I'd better give up smoking and I'd better lose some weight fast. Both of which he swept to one side and said "Don't worry about either of that, we can treat you especially at this stressful time you might feel that you need to have a cigarette if that's your way of coping." He said "Think about that afterwards." He didn't say at the time that it may a contributing factor. I've heard over the course of time that it is one thing that is thought to be a contributory factor. 

I no longer smoke, not because I gave up because I'd just sort of made a conscious effort to give up smoking but during the course of my radiotherapy treatment one of the things that I couldn't face was a cigarette and smoke of any sort, it was just one of the things. Another thing was coffee, went off coffee. But it's not something I consciously did and when I'd got to the end of my various treatments, one thing I really, really wanted that I was really looking forward to was a cigarette, but it was like going back to what would've been day one I suppose because I couldn't understand how I ever started smoking in the first place because it was feeling light headed and awful and I thought no I can't do this. 

So I didn't make a conscious effort to give up smoking I just did, due to other factors, but I never started again. And yes I have heard about the links but I wasn't conscious of it at the time. It still, smoking isn't good for many different things. I wouldn't encourage anybody to smoke. I feel it's a person's right to choose. I don't condemn anybody for doing it either because once you've started it is very difficult to give up. But I do believe that for many different illnesses it's not a good thing.

A few women mentioned that stress and diet may have been a cause. Others talked about their family history of cancer. There is no medical evidence that cervical cancer is related to family history.

A few women mentioned that there needed to be more publicity and awareness of HPV and its link with cervical cancer, so that young women would have a better understanding about why they should attend regularly for cervical screening, be vaccinated against HPV and why they should use condoms to protect themselves during sexual intercourse (for more information see Cervical abnormalities' CIN3 and CGIN - HPV).

“Studies have already shown that the vaccine protects against HPV infection for around 10 years, although experts expect protection to be for much longer.” (NHS Choices August 2014) 

Women need to be vaccinated before they come into contact with the virus. As the virus is transmitted by skin-to-skin contact, usually by sexual activity, this age will vary. The HPV vaccination programme started in the UK in September 2008 with all 12- to 13-year-old and 17- to 18-year-old girls being offered the vaccine.
 
*1   (Walboomers JMM et al. (1999) Human papillomavirus is a necessary cause of invasive cancer worldwide. Journal of Pathology, 189 (1), 12–19.)
*2   Li N et al., 2011. Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: variation by geographical region, histological type and year of publication. International Journal of Cancer 128, 927–935.
*  Koutsky L. 1997. Epidemiology of genital human papillomavirus infection. The American Journal of Medicine, 102 (5A), 3-8
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Last reviewed July 2017.
Last updated July 2017.
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