Cervical cancer is malignant neoplasm of the cervix uteri or cervical area.

It may present with vaginal bleeding, but symptoms may be absent until the cancer is in its advanced stages. Treatment consists of surgery (including local excision) in early stages and chemotherapy and radiotherapy in advanced stages of the disease. Pap smear screening can identify potentially precancerous changes. T reatment of high grade changes can prevent the development of cancer. In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or more.
[citation needed] [1]

Human papillomavirus (HPV) infection is a necessary factor in the development of almost all cases of cervical cancer.[1][2] HPV vaccines effective against the two strains of HPV that currently cause approximately 70% of cervical cancer have been licensed in the U.S, Canada, Australia and the -risk") types of HPV, women EU.[3][4] Since the vaccines only cover some of the cancer causing ("high should seek regular Pap smear screening, even after vaccination.
[5]

Cervix in relation to upper part of vagina and posterior portion of uterus.

e ervi i t e narrow ortion of t e terus where it joins with the top of the vagina. Most ervi al
        

ancers are squamous cell carcinomas, arising in thesquamous flattened epithelial cells that line the
! 

cervi . Adenocarcinoma, arising in glandular epithelial cells is the second most common t pe. Very rarely, cancer can arise in other types of cells in the cervi .
Contents
[hide]


1 Signs and symptoms 2 Causes

o o

2.1 Human papillomavirus infection 2.2 Cofactors

3 Diagnosis

o o o o

3.1 Biopsy procedures 3.2 Precancerous lesions 3.3 Cancer subtypes 3.4 Staging

4 Prevention

o o o o o

4.1 Vaccination 4.2 Condoms 4.3 Smoking 4.4 Nutrition 4.5 Screening

5 Treatment 6 Prognosis 7 Epidemiology 8 History 9 Society and culture 10 References and notes 11 External links

[edit]Signs
# "

and symptoms
][6]

he early stages of cervical cancer may e completely asymptomatic.[

& %

Vaginal leeding, contact

leeding or rarely a vaginal mass may indicate the presence of malignancy. Also, moderate pain
#

during sexual intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease,metastases may e present in the abdomen, lungs or elsewhere.

Cervi

er een n

ei

t ed

itl MR i e f te elvi .

 

Symptoms of advanced cervical cancer may include: loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, single swollen leg, heavy bleeding from the vagina, leaking of urine or faeces from the vagina, and bone fractures. [edit]Causes uman papillomavirus
[ ][8][ ] [ ]

cancer.

Not all of the causes of cervical cancer are known. Several other contributing factors

have been implicated.[9] [edit]Human

2

papillomavi us infection
percent will go on to develop persistent dysplasia or
7 ( 3

In the

nited States each year there are more than 6. million new
54

women, according to the CDC, of which

( 6

cervical cancer. hat is why PV is known as the common cold" of the sexually transmitted infection world. It is very common and affects roughly 8 percent of all sexually active people, whether they have symptoms or not. he most important risk factor in the development of cervical cancer is infection with a high-risk strain of human papillomavirus. he virus cancer link works by triggering alterations in the cells of the cervix, which can lead to the development of cervical intraepithelial neoplasia, which can lead to cancer. Women who have many sexual partners or who have sex with men who had many other partners) have a greater risk.
0 0 @ 1 594
[

][

owever, it is possible to have multiple strains at the same time, including those that can cause
6

cervical cancer along with those that cause warts. he medically accepted paradigm, officially endorsed by the American Cancer Society and other organizations, is that a patient must have been
(

infected with

PV to develop cervical cancer, and is hence viewed as a sexually transmitted disease,

2

this area may be preventative. [edit]Cofacto

P IP II H HG F

although

PV is thought to grow preferentially in the epithelium of the glans penis, and cleaning of
[cit ti ]

skin-to-skin-contact with infected areas. In males, there is no commercially available test for

of condomsreduces, but does not always prevent transmission. Likewise,

but most women infected with high risk

PV will not develop cervical cancer.

PV can be transmitted by PV,

Genital warts are caused by various strains of

(

of cervical cancer cases. ogether with type

6

, they are the prime risk factors for cervical cancer.

PV which are usually not related to cervical cancer.

[ 6]

se

E0

A 4

54

,6 ,
4

, 8 , and CP6

8).

ypes 6 and 8 are generally acknowledged to cause about

9, 68,

, and 8 ),
3C

as probable high-risk
D

6,

, and 66), and

3)

94

subtypes).
AC C 9

][

Of these,
A 3

are classified as high-risk types

More than

types of

PV are acknowledged to exist some sources indicate more than 6, 8, , , , 9, ,

C BB B B 5B 44 4 A 3 3 ) 9 9 9 4 9 9B 4 9 4 3 A A AA A 55 3

in the development of cervical cancer.[8]

1 0

( )

00 0 8

'

PV) infection with high-risk types has been shown to be a necessary factor PV DNA may be detected in virtually all cases of cervical

B9

PV infections in both men and

, 6, 8, , , %

as low-risk 6,

The American Cancer Society provides the following list of risk factors for cervical cancer: human papillomavirus (HPV) infection, smoking, HIV infection, chlamydia infection, stress and stress-related disorders, dietary factors, hormonal contraception, multiple pregnancies, exposure to the hormonal drug diethylstilbestrol, and family history of cervical cancer.
[citation needed] [10]

Early age at first intercourse and first

[17] pregancy are also considered risk factors, magnified by early use of oral contraceptives. There is a

possible genetic risk associated with H A-B7.

There has not been any definitive evidence to support the claim that circumcision of the male partner reduces the risk of cervical cancer, although some researchers say there is compelling epidemiological evidence that men who have been circumcised are less likely to be infected with HPV.
[1 ] [1 ]

However, in men with low-risk sexual behaviour and monogamous female partners,
S

circumcision makes no difference to the risk of cervical cancer. [edit]

iagnosis
sy r cedures

[edit]Bi

While the pap smear is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-cancer requires a biopsy of the cervix. This is often done throughcolposcopy, a magnified visual inspection of the cervix aided by using a diluteacetic acid (e.g. vinegar) solution to highlight abnormal cells on the surface of the cervix.
[1]

Colposcopic impression, the estimate of disease severity based on the visual inspection, forms part of the diagnosis. Further diagnostic and treatment procedures are loop electrical excision procedure ( EEP) and coni ation, in which the inner lining of the cervix is removed to be examined pathologically. These are carried out if the biopsy confirms severe cervical intraepithelial neoplasia .
U T

This large squamous carcinoma (bottom of picture) has obliterated the cervix and invaded the lower uterine segment. The uterus also has a round leiomyoma up higher.

icrograph of a (cervical) adenosquamous carcinoma, a type of cervical cancer. H&E stain.

[edit]Precancer

) (cervical intraepithelial neoplasia grading is used. The naming and histologic classification of cervical carcinoma percursor lesions has changed many
X

times over the 20th century. The World Health term,Cervical Intraepithelial

rgani ation classification[20][21] system was descriptive

Y

of the lesions, naming them mild, moderate or severe dysplasia or carcinoma in situ (CIS). The eoplasia (CI ) was developed to place emphasis on the spectrum of
W W
[21]

abnormality in these lesions, and to help standardise treatment.

W

It classifies mild dysplasia as CI 1, ore recently, CI 2 and CI 3

W W ` W

moderate dysplasia as CI 2, and severe dysplasia and CIS as CI 3.

W

have been combined into CI 2/3. These results are what a pathologist might report from a biopsy. These should not be confused with the Bethesda System terms for Pap smear (cytology) results. Among the Bethesda results: ow-grade Squamous Intraepithelial esion ( SI ) and High-grade Squamous Intraepithelial esion (HSI ) An SI Pap may correspond to CI 1, and HSI may . correspond to CI 2 and CI 3,
W W
[21]

however they are results of different tests, and the Pap smear

results need not match the histologic findings. [edit]Cancer

subty es
[22][23]

Histologic subtypes of invasive cervical carcinoma include the following:

[1]

Though squamous cell

carcinoma is the cervical cancer with the most incidence, the incidence of adenocarcinoma of the cervix has been increasing in recent decades.     
c

squamous cell carcinoma (about 0- 5%

[citation needed]

)
[20]

adenocarcinoma (about 15% of cervical cancers in the UK ) adenosquamous carcinoma small cell carcinoma neuroendocrine carcinoma on-carcinoma malignancies which can rarely occur in the cervix include

us lesi ns

Cervical intraepithelial neoplasia the potential precursor to cervical cancer, is often diagnosed on , examination of cervical biopsies by a pathologist. For premalignant dysplastic changes the CI ,

 

melanoma lymphoma
d

Note that the IGO stage does not incorporate lymph node involvement in contrast to the NM staging for most other cancers. or cases treated surgically, information obtained from the pathologist can be used in assigning a
e d

separate pathologic stage but is not to replace the original clinical stage. [edit]Staging
fg

Cervical cancer is staged by the International ederation of Gynecology and Obstetrics

f

IGO)

staging system, which is based on clinical examination, rather than surgical findings. It allows only the following diagnostic tests to be used in determining the stage: palpation, inspection, colposcopy, endocervicalcurettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, and Xray examination of the lungs and skeleton, and cervical conization. he NM staging system for cervical cancer is analogous to the IGO stage. Stage - full-thickness involvement of the epithelium without invasion into the stroma carcinoma
p f h h

in situ)  Stage I - limited to the cervix  IA - diagnosed only by microscopy; no visible lesions
r t q

  

IA - stromal invasion less than IA - stromal invasion between

mm in depth and
u

and

mm with horizontal spread of

u

IB - visible lesion or a microscopic lesion with more than of more than

q v s

mm of depth or horizontal spread

mm cm or less in greatest dimension

v

  

IB - visible lesion
t

IB - visible lesion more than

cm

Stage II - invades beyond cervix

r

  

IIA - without parametrial invasion, but involve upper / of vagina IIB - with parametrial invasion

Stage III - extends to pelvic wall or lower third of the vagina   IIIA - involves lower third of vagina IIIB - extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney

Stage IV - extends outside the vagina   IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis IVB - distant metastasis

Stage -A young women - conization wis clear margin. Parous women - hysterectomy.
q q

mm or less in horizontal spread mm or less

Stage -A laproscopic lymphadenectomy + vaginal trechelectomy + post operative radiotherapy. Stage B & A . Wertheim's hysterectomy . - schauta vaginal hysterectomy + laparoscopic lymphadenectomy : primary radiotherapy : combined surgery & radiotherapy.
y x
[

[edit]Prevention [edit]Vaccination Mai articl : HPV acci

more than four years. ogether,

precursors to some other cancers associated with PV.

PV vaccines are targeted at girls and women of age 9 to 6 because the vaccine only works if given
[ ]

before infection occurs; therefore, public health workers are targeting girls before they begin having
[ 9]

will be effective for longer, needed is unknown.

however the duration of effectiveness and whether a booster will be

he use of the vaccine in men to prevent genital warts, anal cancer, and interrupt transmission to

women or other men is initially considered only a secondary market. he high cost of this vaccine has been a cause for concern. Several countries have or are considering

programs to fund

PV vaccination.

[edit]Condoms

Condoms offer some protection against cervical cancer.[ cervical cancer.[

Evidence on whether condoms protect

against

PV infection is mixed, but they may protect against genital warts and the precursors to
]

hey also provide protection against other S Ds, such as IV and Chlamydia,

which are associated with greater risks of developing cervical cancer. Condoms may also be useful in treating potentially precancerous changes in the cervix. Exposure to semen appears to increase the risk of precancerous changes CIN ), and use of condoms helps to

[ ]

cause these changes to regress and helps clear

][

PV.

One study suggests

that prostaglandin in semen may fuel the growth of cervical and uterine tumours and that affected women may benefit from the use of condoms.
f
]

sex. he vaccines have been shown to be effective for at least

to 6

[ 6][

and

cause about 9 % of genital wart cases.

PV vaccines have also been shown to prevent

]

PV types 6 and 8 currently cause about

% of cervical cancer cases.

[ 8]

years, and it is believed they

Cervarix has been shown to be 9 % effective in preventing

Gardasil, is a vaccine against

PV types 6,

, 6 & 8 which is up to 98% effective.

PV strains 6 and 8 and is effective for

Stage B ,
x

- chemotherapy

PV types 6

[edit]Smoking Carcinogens from tobacco increase the risk for many cancer types, including cervical cancer, and women who smoke have about double the chance of a nonsmoker to develop cervical cancer. [edit]Nutrition Fruits and vegetables
j
[

igher levels of vegetable consumption were associated with a

[ 6]

% decrease risk of

PV

persistence. Vitamin A

here is weak evidence to suggest a significant deficiency of retinol can increase chances of cervical
n j n

dysplasia, independently of PV infection. A small n~=500) case-control study of a narrow ethnic group native Americans in New Mexico) assessed serum micro-nutrients as risk factors for cervical dysplasia. Subjects in the lowest serum retinol quartile were at increased risk of CIN I compared with women in the highest quartile.
j g
[

owever, the study population had low overall serum retinol, suggesting deficiency. A study of serum
[ 8]

retinol in a well-nourished population reveals that the bottom 0% had serum retinol close to that of the highest levels in this New Mexico sub-population. Vitamin C
j p g

Risk of type-specific, persistent

PV infection was lower among women reporting intake values

[ 9]

of vitamin C in the upper quartile compared with those reporting intake in the lowest quartile. Vitamin E

PV clearance time was significantly shorter among women with the highest compared with the
n

lowest serum levels of tocopherols, but significant trends in these associations were limited to infections lasting </=120 days. Clearance of persistent PV infection lasting >120 days) was not significantly associated with circulating levels of tocopherols. Results from this investigation support
[ 0]

uterine cervix.

positive patients with cervical intraepithelial neoplasia. he risk of dysplasia was four times higher for an alpha-tocopherol level < .95 mumol/l. Folic acid
j q
[ 1]

igher folate status was inversely associated with becoming

j

PV test-positive. Women with higher

folate status were significantly less likely to be repeatedly PV test-positive and more likely to become test-negative. Studies have shown that lower levels of antioxidants coexisting with low levels of folic acid increases the risk of CIN development. Improving folate status in subjects at risk of
[ 2][ ]

of cervical cancer.

getting infected or already infected with high-risk

g h h

PV may have a beneficial impact in the prevention

A statistically significantly lower level of alpha-tocopherol was observed in the blood serum of
m h

an association of micronutrients with the rapid clearance of incident oncogenic

h

PV infection of the

ig g h
][

lk

j j j m

PV-

However, another study showed no relationship between folate status and cervical dysplasia. Carotenoids

he likelihood of clearing an oncogenic HPV infection is significantly higher with increasing levels
]

plasma [lycopene] concentrations compared with women with the lowest plasma lycopene concentrations. hese data suggests that vegetable consumption and circulating lycopene may be protective against HPV persistence. [edit]Screening Mai articl : Pap t
xw w v u r r t
[ 6][ 9][ 5]

The widespread introduction of the Papanicolaou test, or Pap

[6]

been credited with dramatically reducing the incidence and mortality of cervical cancer in developed countries. Pap smear screening every 5 years with appropriate follow-up can reduce cervical cancer incidence by up to 80%.
|
[ 6]

Abnormal Pap smear results may suggest the presence of cervical

intraepithelial neoplasia potentially premalignant changes in the cervix) before a cancer has developed, allowing examination and possible preventive treatment. If premalignant disease or cervical cancer is detected early, it can be monitored or treated relatively noninvasively, with little impairment of fertility. Cervical cancer screening is typically recommended starting three years or more after first sex, or starting at age 21 to 25.
[ 6]

done vary from once a year to once every five years, in the absence of abnormal results.
[

Guidelines vary on how long to continue screening, but well screened women who have not
{ { { }
][ 8][ 9]

had abnormal smears can stop screening about age 60 to 0.

To take a Pap smear, the vagina is held open with a speculum, the loose surface cells on the cervix are scraped using a specially shaped spatula and a brush, and the cells are spread on a microscope slide. At a laboratory the slide is stained, examined for abnormal cells and findings are reported. ntil recently the Pap smear has remained the principal technology for preventing cervical cancer.
[50]

However, following a rapid review of the published literature, originally commissioned by Although it was probably intended to improve on the accuracy of the Pap test, its main advantage has been to reduce the number of inadequate smears from around 9% to around 1%. need to recall women for a further smear. Automated technologies have been developed with the aim of improving on the interpretation of

[51]

smears, normally carried out by cytotechnologists.

[52]

nfortunately these on the whole have proven less

useful; although the more recent reviews suggest that generally they may be no worse than human interpretation.

NICE,

liquid based cytology has been incorporated within the K national screening programme.

  ~

][ 8][citati

Recommendations for how often a Pap smear should be

w yx

{ { }

uu

of lycopenes.[

A 56% reduction in HPV persistence risk was observed in women with the highest

t ar for cervical cancer screening has

This reduces the

The HPV test is a newer technique for cervical cancer triage which detects the presence of human papillomavirus infection in the cervix. It is more sensitive than the pap smear less likely to produce false negative results), but less specific more likely to produce false positive results) and its role in routine screening is still evolving. Since more than 99% of invasive cervical cancers worldwide contain HPV, some researchers recommend that HPV testing be done together with routine cervical active population) others suggest that routine HPV testing would cause undue alarm to carriers, more unnecessary follow-up testing and treatment. HPV testing along with cytology significantly increases the cost of screening. Various experimental techniques, such as visual inspection using acetic acid, sometimes with special lights speculoscopy), or taking pictures for expert evaluation cervicography) have been evaluated as adjuncts to or replacements for Pap smear screening, especially in countries where Pap smear screening is prohibatively expensive. There are efforts to develop low cost HPV tests which might be used for primary screening of older women in less developed countries. [edit]Treatment Microinvasive cancer stage IA) is usually treated by hysterectomy removal of the whole uterus including part of the vagina). or stage IA2, the lymph nodes are removed as well. An alternative for patients who desire to remain fertile is a local surgical procedure such as a loop electrical excision procedure LEEP) or cone biopsy.[53] If a cone biopsy does not produce clear margins,[54] one more possible treatment option for patients who want to preserve their fertility is a trachelectomy.
[55] [15]

This attempts to surgically remove the cancer

while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy. It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care,[56] as few doctors are skilled in this procedure. Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown. If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the patient is under general anesthesia in the operating room, a hysterectomy may still be needed. This can only be done during the same operation if the patient has given prior consent. Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the uterus for pathologic evaluation. A radical trachelectomy can be performed abdominally opinions as to which is better.
[59] [57]

or vaginally

A radical abdominal trachelectomy with lymphadenectomy usually

only requires a two to three day hospital stay, and most women recover very quickly approximately six weeks). Complications are uncommon, although women who are able to conceive after surgery are susceptible to preterm labor and possible late miscarriage.
[60]

It is generally recommended to wait

screening.

But, given the prevalence of HPV around 80% infection history among the sexually

[58]

and there are conflicting

at least one year before attempting to become pregnant after surgery.

[61]

Recurrence in the residual

[56]

cervix is very rare if the cancer has been cleared with the trachelectomy.

Yet, it is recommended for

patients to practice vigilant prevention and follow up care including pap screenings/colposcopy, with biopsies of the remaining lower uterine segment as needed every 34 months for at least 5 years) to monitor for any recurrence in addition to minimizing any new exposures to HPV through safe sex practices until one is actively trying to conceive. Early stages IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy. Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy internal radiation). Patients treated with surgery who have high risk features found on pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse. Larger early stage tumors IB2 and IIA more than 4 cm) may be treated with radiation therapy and cisplatin-based chemotherapy, hysterectomy which then usually requires adjuvant radiation therapy), or cisplatin chemotherapy followed by hysterectomy. Advanced stage tumors IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy.

On June 15, 2006, the

[62]

chemotherapy drugs, hycamtin and cisplatin for women with late-stage IVB) cervical cancer treatment. Combination treatment has significant risk of neutropenia, anemia,

and thrombocytopenia side effects. Hycamtin is manufactured by GlaxoSmithKline. [edit]Prognosis Prognosis depends on the stage of the cancer. With treatment, the 5-year relative survival rate for the earliest stage of invasive cervical cancer is 92%, and the overall all stages combined) 5-year survival rate is about 72%. These statistics may be improved when applied to women newly diagnosed, bearing in mind that these outcomes may be partly based on the state of treatment five years ago when the women studied were first diagnosed.
[63]

With treatment, 80 to 90% of women with stage I cancer and 50 to 65% of those with stage II cancer are alive 5 years after diagnosis. Only 25 to 35% of women with stage III cancer and 15% or fewer of those with stage IV cancer are alive after 5 years.

[64]

According to the International ederation of Gynecology and Obstetrics, survival improves when radiotherapy is combined with cisplatin-based chemotherapy.[65] As the cancer metastasizes to other parts of the body, prognosis drops dramatically because treatment of local lesions is generally more effective than whole body treatments such as chemotherapy. Interval evaluation of the patient after therapy is imperative. Recurrent cervical cancer detected at its earliest stages might be successfully treated with surgery, radiation, chemotherapy, or a combination

S ood and Drug Administration approved the use of a combination of two

of the three. Thirty-five percent of patients with invasive cervical cancer have persistent or recurrent disease after treatment.
[

Average years of potential life lost from cervical cancer are 25.3 (SEE Cancer Statistics eview

1 75-2000,

ational Cancer Institute ( CI)). Approximately 4, 00 women were projected to die in

0 2001 in the US of cervical cancer ( ST ), and the annual incidence was 13,00 in 2002 in the US, as calculated by SEE . Thus the ratio of deaths to incidence is approximately 35.4%. egular screening has meant that pre cancerous changes and early stage cervical cancers have
[ 7]

been detected and treated early. Figures suggest that cer vical screening is saving 5,000 lives each year in the UK by preventing cervical cancer. the UK. [edit]Epidemiology

About 1,000 women per year die of cervical cancer in

Age-standardi ed death from cervical cancer per 100,000 inhabitants in 2004.[ no data less than 2.4 2.4-4.

4. -7.2 7.2- .

. -12

12-14.4 14.4-1 .

1 . -1 .2 1 .2-21. 21. -24 24-2 .4 more than 2 .4

Worldwide, cervical cancer is twelfth most common year.

[71]

and the fifth most deadly cancer in women. per 100,000 per
[72] [73]

Approximately 0% of cervical cancers occur in developing countries Worldwide, in 200 , it

was estimated that there were 473,000 cases of cervical cancer, and 253,500deaths per year.

In the United States, it is only the th most common cancer of women. In 1

[ ]

were diagnosed in the US and about 4, 00 died. In 200 in the US an estimated 11,000 new cases were expected to be diagnosed, and about 3, 70 were expected to die ofcervical cancer.[

3]

affects about 1 per 100,000 women per year and kills about

, about 12, 00 women

[70]

It

Among

gynecological cancers it ranks behind endometrial cancer and ovarian cancer. The incidence and mortality in the S are about half those for the rest of the world, which is due in part to the success of
[74]

was 7 per 100,000 women in 2004.

Cervical cancer deaths decreased by approximately 74% in the

[69]

last 50 years, largely due to widespread Pap smear screening. The annual direct medical cost of cervical cancer prevention and treatment is prior to introduction of the HPV vaccine was estimated at $6 billion.
[69]

cervical cancer in 2004.

is the twelfth most common cancer in women, accounting for 2% of all female cancers, and is the

second most common cancer in the under 35s females, after breast cancer. The for the K).
[75]

K's European age-

With a 42% reduction from 1988-1997 the NHS implemented screening programme

has been highly successful, screening the highest risk age group 2549 years) every 3 years, and those ages 5064 every 5 years. In Canada, an estimated 1,300 women will be diagnosed with cervical cancer in 2008 and 380 will die.
[76]

In Australia, there were 734 cases of cervical cancer 2005). The number of women diagnosed with cervical cancer has dropped on average by 4.5% each year since organised screening began in 1991 19912005).
[77]

Regular two-yearly Pap tests can reduce the incidence of cervical cancer by up to 90%
[78]

in Australia, and save 1,200 Australian women dying from the disease each year. [edit]History 400 BCE - Hippocrates: cervical cancer incurable 1925 - Hinselmann: invented colposcope 1928 - Papanicolaou: developed Papanicolaou technique 1941 - Papanicolaou and Trout: Pap smear screening

       

1946 - Ayer: Aylesbury spatula to scrape the cervix, collecting sample for Pap smear 1976 - Zur Hausen and Gisam: found HPV DNA in cervical cancer and warts 1988 - Bethesda System for reporting Pap results developed 2006 - irst HPV vaccine DA approved

Epidemiologists working in the early 20th century noted that cervical cancer behaved like a sexually transmitted disease. In summary: 1. Cervical cancer was common in female sex workers.

standardised mortality is 2.4/100,000 per year 2007) Cancer Research

K Cervical cancer statistics

In the

nited Kingdom, the age-standardised European) incidence is 8.5/100,000 per year 2006). It

In the European

nion, there were about 34,000 new cases per year and over 16,000 deaths due to
[46]

screening with the Pap smear.

[6]

The incidence of new cases of cervical cancer in the

nited States

2. It was rare in nuns, except for those who had been sexually active before entering the convent. Rigoni in 1841) 3. It was more common in the second wives of men whose first wives had died from cervical cancer. 4. It was rare in Jewish women.
[79]

5. In 1935, Syverton and Berry discovered a relationship between RPV Rabbit Papillomavirus) and skin cancer in rabbits. HPV is species-specific and therefore cannot be transmitted to rabbits) This led to the suspicion that cervical cancer could be caused by a sexually transmitted agent. Initial research in the 1940s and 1950s put the blame on smegma e.g. Heins et al. 1958). disease. In summary, HSV was seen as a likely cause
[81] [80]

1960s and 1970s it was suspected that infection with herpes simplex virus was the cause of the because it is known to survive in the female

reproductive tract, to be transmitted sexually in a way compatible with known risk factors, such as promiscuity and low socioeconomic status. Herpes viruses were also implicated in other malignant diseases, including Burkitt's lymphoma, Nasopharyngeal carcinoma, Marek's disease and the Luck renal adenocarcinoma. HSV was recovered from cervical tumour cells. A description of human papillomavirus HPV) by electron microscopy was given in 1949, and HPVcancer tissue. cancers.
[4] [82]

It has since been demonstrated that HPV is implicated in virtually all cervical

Specific viral subtypes implicated are HPV 16, 18, 31, 45 and others.

In work that was initiated in the mid 1980s, the HPV vaccine was developed, in parallel, by Queensland in Australia, and the

Administration

DA) approved the first preventive HPV vaccine, marketed by Merck & Co. under the

trade name Gardasil. [edit]Society

and culture

According to a survey, only 40% of American women had heard of human papillomavirus HPV) infection and only 20% had heard of its link to cervical cancer.[84

.S. National Cancer Institute.

[83]

In 2006, the .S. ood and Drug

researchers at Georgetown

niversity Medical Center, the

DNA was identified in 1963.[citati

eeded]

It was not until the 1980s that HPV was identified in cervical

niversity of Rochester, the

During the

niversity of