Cervical Cancer

What is it?
Cancer of the cervix affects the cells lining the entrance to the womb.
About 2,700 women are diagnosed with cervical cancer each year in the UK. Thanks to the cervical cancer screening programme, which checks 4.4 million women every year, the number of women being diagnosed has fallen by more than 40 per cent since 1988.
Cervical cancer develops in a series of precancerous changes, starting with mild abnormalities in the cells and progressing towards full cancer. Each year, about 24,000 women are found to have the most serious form of precancerous abnormalities (CIN 3 changes) when they have a cervical smear test.
By detecting these changes before cancer has become fully established, cervical screening now saves approximately 4,500 lives a year in England. As a result, the death rate has plummeted by 60 per cent in the past 30 years.
About 70 per cent of women treated for invasive cervical cancer are alive five years later, although survival rates are much higher when the disease is caught in its earlier stages.
What's the cause?
Exactly how cervical cancer develops isn't known, but it's most likely to result from a combination of triggers. Risk factors include:
Infection with certain types of human papilloma virus (HPV), but not the type that causes genital warts. HPV is found in virtually all cases of cervical cancer and HPV types 16 and 18 carry the highest risk. A vaccine against HPV is licensed for use in the UK, and the Joint Committee on Vaccination and Immunisation has recommended to the Government that the vaccine be given to all girls when they're 12 or 13 years old. The Government has accepted the advice but is considering funding, as a course of the vaccine costs several hundred pounds. In Scotland, a vaccination programme is due to start in 2008.
Other sexually transmitted infections in combination with HPV. Women with chlamydia or HIV as well as HPV have a significantly increased risk of cervical cancer.
Any factor that increases the risk of exposure to HPV, including having many sexual partners, first having sex at a young age and not using barrier contraceptives such as condoms.
Smokers are twice as likely to develop the disease as non-smokers because chemicals in cigarette smoke damage special cells in the cervix that normally fight the disease.
The contraceptive pill directly increases the risk by a very small amount.
Not having a smear test. Almost half of all new cases of cervical cancer occur in women who've never had a smear test, which means early, pre-cancerous stages of the disease aren't detected or treated.
What are the symptoms?
The most common symptoms of cervical cancer include:
Bleeding between periods or after sex, or new bleeding after the menopause
Unpleasant smelling vaginal discharge
Discomfort/pain during intercourse
Any of these symptoms may have causes other than cervical cancer, but it is important to get them checked by your GP, even if you've attended your routine cervical smear test.
How's it diagnosed?
All women aged 20 to 64 who've had sexual intercourse should have a smear test every three to five years. This can be taken by a doctor or nurse at your GP surgery, family planning clinic or well woman clinic.
The NHS Cervical Screening Programme first invites a woman to have a smear test at the age of 25. After that, women are offered screening every three years until the age of 49, and then every five years until 64.
Women over 64 can stop having smear tests if the previous two in the past ten years were negative.
Smear tests detect the early changes of cervical cancer. This is a positive test. Sometimes all that's needed is to repeat the test a few months later to see if the abnormalities have healed.
Most women will be offered further tests, in particular a colposcopy, where the doctor examines the cervix with a microscope to get a closer look at the cells and take a biopsy (rather like a more intensive smear test).
What's the treatment?
This will depend on the stage of the cancer, but generally aims to destroy or remove abnormal cells. Treatments for precancerous changes include laser, cryotherapy (freezing), cone biopsy (removing a cone-shaped piece of tissue) and hysterectomy.
In invasive cancer, radiotherapy and chemotherapy may be offered.
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This article was last medically reviewed by Dr Trisha Macnair in August 2007.