Risk Factors for Cervical Cancer Development
- Rarely or never screened.
- HPV persistence.
- Immunosuppression: HIV, high-dose steroid use.
- History of lower genital tract neoplasia (vaginal, vulvar, or anal).
- Increasing number of lifetime sexual partners (increases risk of HPV acquisition).
- Early age of sexual activity (increases risk of HPV acquisition).
- Infection with C. trachomatis and possibly herpes simplex virus (HSV).
- Tobacco smoking:1 2 Current, and to a lesser extent, past tobacco smoking increases risk of cervical squamous cell carcinoma.
- Use of oral contraceptives: long-term use (greater than 10 years; possible slight increase after 5 years) increases risk for cervical squamous cell carcinoma.
- More than three full-term pregnancies.
Risk Factors for HPV Infection
Risk factors for HPV infection are not the same as risk factors for cervical cancer. Persistent HPV infection is the most important risk factor for cervical cancer precursors and cervical cancer, independent of other risk factors such as smoking. The longer high-risk HPV infection is present, the greater the risk of high-grade squamous intraepithelial lesions (HSIL). It takes decades for HPV infection to lead to invasive cancer. The peak age for HPV infection is in the early 20s, leading to a peak prevalence of HSIL around age 30, with the highest cancer risk at ages 45 to 60.
1International Collaboration of Epidemiological Studies of Cervical Cancer, Appleby P, Beral V, Berrington de González A, Colin D, Franceschi S, Goodill A, Green J, Peto J, Plummer M, Sweetland S. Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. International Journal of Cancer 2006;118(6):1481–1495.
2Plummer M, Herrero R, Franceschi S, Meijer CJ, Snijders P, Bosch FX, de Sanjosé S, Muñoz N; IARC Multi-centre Cervical Cancer Study Group. Smoking and cervical cancer: pooled analysis of the IARC multi-centric case—control study. Cancer Causes and Control 2003;14(9):805–814.