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Cervical Cancer Prevention (PDQ®)

Overview

Note: Separate PDQ summaries on Cervical Cancer Screening and Cervical Cancer Treatment are also available.

Avoidance of Human Papillomavirus Infection

Based on solid evidence, the following measures are effective to avoid human papillomavirus (HPV) infection, and thus cervical cancer:

Abstinence from sexual activity

Magnitude of Effect: Abstinence prevents HPV infection.

  • Study Design: Evidence obtained from cohort and case-control studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.

Barrier protection and/or spermicidal gel during sexual intercourse

Magnitude of Effect: Total use of barrier protection decreases cancer incidence, relative risk of 0.4 (95% confidence interval [CI], 0.2–0.9).

  • Study Design: Evidence obtained from cohort and case-control studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.

Based on fair evidence, vaccination against HPV-16/HPV-18 is effective to avoid HPV infection, and thus cervical cancer.

Magnitude of Effects: Vaccination against HPV-16 and HPV-18 reduces incident and persistent infections with efficacy of 91.6% (95% CI, 64.5–98.0) and 100% (95% CI, 45–100), respectively. Efficacy beyond 6 to 8 years is not known.

  • Study Design: Evidence obtained from randomized controlled trials.
  • Internal Validity: Good.
  • Consistency: Not applicable.
  • External Validity: Good.

Screening via Gynecologic Examinations and Cytologic Screening

Based on solid evidence, screening via regular gynecologic examinations and cytologic test (Papanicolaou [Pap] smear) with treatment of precancerous abnormalities decreases the incidence and mortality of cervical cancer. Screening is not beneficial in detecting invasive cancer in women younger than 25 years because of the low prevalence of invasive disease, and the harms outweigh the benefits. Screening is not beneficial in women older than 60 years if they have had a history of recent negative tests.

Magnitude of Effect: Estimates from population studies suggest that screening may decrease cancer incidence and mortality by more than 80%.

  • Study Design: Evidence obtained from cohort or case-control studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.

Cigarette Smoke

Based on solid evidence, cigarette smoking, both active and passive, increases the risk of cervical cancer.

Magnitude of Effect: Among HPV-infected women, current and former smokers have approximately two to three times the incidence of high-grade cervical intraepithelial neoplasia or invasive cancer. Passive smoking is also associated with increased risk but to a lesser extent.

  • Study Design: Evidence obtained from cohort or case-control studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.

Reproductive Behavior

High parity

Based on solid evidence, high parity is associated with increased risk of cervical cancer.

Magnitude of Effect: Among HPV-infected women, those who have had seven or more full-term pregnancies have approximately four times the risk of squamous cell cancer compared with nulliparous women, and two to three times the risk of women who have had one or two full-term pregnancies.[1]

  • Study Design: Evidence obtained from cohort or case-control studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.

Long-term use of oral contraceptives

Based on solid evidence, long-term use of oral contraceptives is associated with increased risk of cervical cancer.

Magnitude of Effect: Among HPV-infected women, those who used oral contraceptives for 5 to 9 years have approximately three times the incidence of invasive cancer, and those who used them for 10 years or longer have approximately four times the risk.[2]

  • Study Design: Evidence obtained from cohort or case-control studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.

References

  1. Muñoz N, Franceschi S, Bosetti C, et al.: Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet 359 (9312): 1093-101, 2002. [PUBMED Abstract]
  2. Moreno V, Bosch FX, Muñoz N, et al.: Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet 359 (9312): 1085-92, 2002. [PUBMED Abstract]
  • Updated: October 17, 2014