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Cancer of the uterine cervix, the portion of the uterus that is attached to the top of the vagina. Ninety percent of cervical cancers arise from the flattened or "squamous" cells covering the cervix. Most of the remaining 10% arise from the glandular, mucus-secreting cells of the cervical canal leading into the uterus.

Causes and Risks

The development of cervical cancer is gradual and begins as a pre-cancerous condition called dysplasia. In this form it is 100% treatable, usually without the need for hysterectomy. Dysplasia, depending on its severity, can resolve without treatment. But more often it eventually progresses to actual cancer -- called "carcinoma in situ" (CIS) when it has not yet spread, and "microinvasive" when it has spread only a few millimeters into the surrounding tissue and has not yet penetrated blood vessels and lymph channels.

This process may take many years, but once the cancer is established it quickly spreads further into the nearby tissues or to other organs, usually the intestines, liver, and lung.

There are often no symptoms of cervical cancer until the disease is advanced. The overwhelming majority of women diagnosed today with cervical cancer have either not had regular Pap smears or they have not followed up after having an abnormal smear. Not having regular Pap smears is the single greatest risk factor for a bad outcome in women who develop cervical cancer.

The risk factors for cervical cancer are:

Infection with human papilloma virus or HPV, the cause of genital warts. Types 16, 18, 45 and 56 are thought to be especially dangerous. But not all women who have HPV infection develop cervical cancer. Scientists believe that certain other factors they call co-factors are involved in its development. One co-factor is smoking. Tobacco use damages the immune system and interferes with the body's ability to resist HPV infection in the cervix.
Early age at first sexual intercourse.
Multiple sexual partners and/or partners who have multiple partners.
In the early 1970's, it was discovered that women whose mothers took an estrogen drug during pregnancy called DES (diethylstilbestrol) are at risk of a rare form of cervical and vaginal cancer. This drug was used from 1938 until 1971 - and was sometimes combined with prenatal vitamins in the mistaken belief that it prevented miscarriages. For more information go to the DES Action web page.
There is a small increased risk of abnormal Pap smears among women who take birth control pills. It is thought that this is because such women are more sexually active, are less likely to use condoms, and have more frequent Pap smears in order to be prescribed the birth control pill.
Women whose immune systems are weakened -- such as those with HIV infection or women who have received organ transplants and are taking drugs to suppress the immune system -- may be at a higher risk.
Infections with genital herpes or chronic chlamydia infections, both sexually transmitted diseases, may increase risk
Poor women may be at higher risk because they are not able to afford regular pap smears.

Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the US, where it has been declining. This is due almost entirely to the use of the Pap smear, which has reduced the death rate from this disease by 70% since it was introduced in 1941. Yet according to the American Cancer Society, 12,800 women were diagnosed with cervical cancer in the year 2000, and there were 4,600 deaths from this disease.

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