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The relationship between cervical cancer and sexual activity was first noted more that 150 years ago. Since then it has been assumed that sexually transmitted infection may be the underlying mechanism. Many sexually transmitted infections have been suggested and linked to the disease. Perhaps the greatest difficulty has been that those who have acquired one sexually transmitted disease have been at risk of acquiring others. A variety of possible organisms have been implicated including Chlamydia trachomatis and herpes simplex. Only in the last twenty years have studies of cervical cancer demonstrated that at least 99.8% are associated with the human papillomavirus (HPV). There are many ‘types’ of HPV with HPV type 16 accounting for 50%, HPV 18 for 12%, HPV 45 for 8% and HPV 31 for 5%.
Acquisition of HPV does not necessarily mean that pre-malignancy or malignancy of the cervix will occur. Experts believe that 20% of women will acquire HPV at some time in their lives but the virus is removed from the body in the majority. A number of factors determine whether the HPV will not be eliminated and whether pre-malignancy and then malignancy will occur. Some people have a genetic predisposition to malignancy. Smoking is thought to reduce the efficiency of the immune system increasing the risks. The socially disadvantaged are most at risk of cervical cancer. The condom method of contraception provides protection against cervical cancer. Women who have used oral contraception are twice as likely to have high grade pre-malignant conditions of the cervix compared to those who never used it probably because they have been less likely to have used a barrier method of contraception.
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