Incidence and prevalence

Cancer of the cervix is the second most common cancer among women worldwide.

There were 524,000 new cases (incidence) in 1995 alone.

80% of the cases of cancer of the cervix are in the developing countries.

Western Europe, North America and the Eastern Mediterranean have the lowest rates ,while Latin America, Sub- Saharan Africa and South-East Asia have the highest rates.

Cause/ Causative agent of carcinoma of the cervix

There is evidence that carcinoma of the cervix can be caused by the Human Papilloma Virus (HPV). Human papilloma virus is sexually transmitted. This virus is found in 95% of the cases of carcinoma of the cervix.

It is thought that the virus does not cause the cancer alone. Other co-factors might be important.

Risk factors for the cancer of the cervix.

a) Sexual intercourse and marital status: Sexual intercourse is the major factor in the genesis of carcinoma of the cervix (The squamous type). Medical records of nuns have shown that carcinoma of the cervix is very rare in this group of ladies. The fact that cancer of the cervix is very common among prostitutes and almost unknown among virgins suggests that the disease could be linked to sexual intercourse.

Number of husbands and number of coital partners and how promiscuous the women have been are important factors.

b) Genital warts and other sexual transmitted diseases: past history and/or present occurrence of clinical genital warts is an important risk factor in the development of carcinoma of the cervix.

Women with sexually transmitted diseases like gonorrhoea, syphilis,trichomonos and genital herpes have a higher incidence of cervical cancer than matched controls.

There appears to be some connection between herpes virus type 2 hominis and cervical cancer, but it is not as strong as the association between human papilloma virus (HPV) and cancer of the cervix.

c) The age at first intercourse: The age at first sexual intercourse is very significant and there is no doubt at all that sexual intercourse at adolescence predisposes women to this dredful disease.

Other risks such as early marriage ,early coitus, repeated childbirth and early childbearing are also probably related to the age at first sexual intercourse.

d) Oral contraceptives: Recent evidence suggests a possible relationship between the use of oral contraceptives and the development of invasive cervical cancer. A recent WHO study found that there is an increased risk of carcinoma of the cervix with increased duration of pill use and with the use of oral contraceptives with high oestrogen.

e) Socio-economic class: There is higher incidence of cervical cancer among women from lower socio-economic status, and although poor personal hygeine, sexual hygiene, loose living habits, unstable marriage and prostitution may all be contributory, it is most likely that early sexual intercourse among this group is the most significant factor.

Prevention and control of Cancer of the cervix

a)Primary prevention: The causative factors are not yet fully understood. So at this time primary prevention is not possible .However as seen in developed countries, reduction in the incidence of cancer of the cervix can be achieved by birth control and personal hygiene.

b)Secondary Prevention: This is essentially early detection od cases through screening and treatment by radical surgery and radiotherapy.

For carcinoma in site the 5-year survival rate is nearly 100%, therefore early detection is extremely important. It is 79% for locally invasive disease and 45% for regionally invasive disease.

References:

Page 291, Chapter 6. Epidemiology of Chronic Non-communicable Diseases and Conditions.Park’s Textbook of Preventive and Social Medicine. 17th edition by K. Park

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