Cervical Cancer

• What is the incidence of cervical cancer?
• How many women die from cervical cancer?
• What are the risk factors for cervical cancer?
• Oral contraceptives and HPV

What is the incidence of cervical cancer?

In 2006, there were 2, 321 new registrations of invasive cervical cancer in England¹.

Cervical cancer incidence fell by 42 per cent between 1988 and 1997 (England and Wales). This fall is directly related to the cervical screening programme².

There was a 25 per cent decrease in the incidence rate of cervical cancer for women under the age of 70 from 1990 to 1992. This has been attributed to a rapid increase in coverage of the cervical screening programme which occurred from 1989 onwards³.

In 2005, the age-standardised (European) annual incidence rate of cervical cancer in the UK is 8.4 per 100,000 females.¹.

In 1999, 21,617 women in England were found to have the most severe type of CIN (CIN 3)⁵.

Cervical screening now saves approximately 4,500 lives per year in England⁶.

Cervical screening prevents up to 3,900 cases of cervical cancer per year in the UK⁷.

UK incidence rates are slightly below the European Union average while the mortality rates are slightly above⁸.

An estimated 471,000 new cases of cervical cancer are diagnosed each year in the world with 80 per cent of these occurring in the less developed world⁸.

¹Cancer Research UK
²National Statistics, Health Quarterly Statistics 07, Autumn 2000
³Cancer Incidence and Mortality in England and Wales: trends and risk factors. Swerdlow, Silva and Doll OUP 2001
⁴Cancer Research UK, June 2006
⁵National Statistics MB1 No 30 Registrations of cancer diagnosed in 1999
⁶Julian Peto et al, The Lancet 2004 (Vol.364: 249-56)
⁷Sasieni, British Journal of Cancer 1996 Apr; 73(8):1001-5
⁸Cancer Stats, Cervical Cancer - UK, January 2003, Cancer Research UK, London

How many women die from cervical cancer?¹

In 2007, 756 women died from cervical cancer in England.

Mortality rates generally increase with age with the highest number of deaths occurring in the 75-79 age group. Less than 6 per cent of cervical cancer deaths occur in women under 35.

Cervical cancer mortality rates in 2006 (2.4 per 100,000 females) are nearly 70% lower than they were 30 years earlier (7.5 per 100,000 females in 1976). Cervical cancer is the sixteenth most common cause of cancer deaths in women in UK.

The latest relative survival figures for England show that 66 per cent of women diagnosed with cervical cancer between 2000 and 2001 were alive five years later.

What are the risk factors for cervical cancer?

The exact cause of cervical cancer is not known. However, it is known that:

• Some types of Human Papilloma Virus, in particular HPV 16 and HPV 18, are found in over 99% of cervical cancers. These are known as 'high risk' types. Other types (eg HPV 6 and HPV 11) cause genital warts. Those which cause genital warts do not place a woman at increased risk of developing cervical cancer. Other types of HPV appear to be harmless.

• The majority of sexually active women will come into contact with high risk HPV types at some time in their life. In most women, their body's own immune system will get rid of the infection without them ever knowing it was there. Only a minority who are positive for high risk HPV types will develop cervical abnormalities (CIN) which could develop into cervical cancer if left untreated.

• Women with many sexual partners, or whose partners have had many partners, are more at risk of developing cervical cancer. This is because their behaviour is more likely to expose them to HPV. However, a woman with only one partner could contract HPV if that partner has previously been in contact with the virus.

• Women who are immunosuppressed (for example, those who are taking immunosuppressive drugs after an organ transplant, or women who are HIV positive) may be at increased risk of developing cervical cancer.

• Women who smoke are about twice as likely to develop cervical cancer as non-smokers. This may be because smoking is associated with high risk health behaviours or because it suppresses the immune system allowing the persistence of high risk HPV infection. Stopping smoking appears to help clinical abnormalities to return to normal.

• Using a condom offers only very limited protection from transmission of HPV.

• Long term use of oral contraceptives increases the risk of developing cervical cancer but the benefits of taking oral contraceptives far outweigh the risks for the majority of women.

• Women with a late first pregnancy have a lower risk of developing cervical cancer than those with an early pregnancy. The risk rises with the number of pregnancies.

Despite the risk factors, cervical screening can prevent around 75% of cancer cases in women who attend regularly. Screening is one of the best defences against cervical cancer. Many of those who develop it have never been screened. The biggest risk factor therefore is non-attendance.

Oral contraceptives and HPV

Evidence suggests that long-term use of combined oral contraceptives or progestogen-only injectable contraceptives is associated with a small increased risk of cervical cancer. The level of risk returns to that for never-users within 10 years of stopping use.
Oral contraceptives and cervical cancer (245kb PDF)

The NHS Cervical Screening Programme responds to a systematic review of cervical cancer and use of hormonal contraceptives published in The Lancet and explains why women should choose to accept their invitations for cervical screening.
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New research examining the effects of long-term use of oral contraceptives on the occurrence of cervical cancer in women with human papilloma virus (HPV) has been published in The Lancet. The NHS Cervical Screening Programme answers your questions
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