A risk factor is anything that changes your chance of gettinga disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers. But having a risk factor, or even several, does not mean that you will get the disease.

Several risk factors increase your chance of developing cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these risk factors increase the odds of developing cervical cancer, many women with these risks do not develop this disease. When a woman develops cervical cancer or pre-cancerous changes, it may not be possible to say with certainty that a particular risk factor was the cause.

In thinking about risk factors, it helps to focus on those you can change or avoid (like smoking or human papilloma virus infection), rather than those you cannot (such as your age and family history). However, it is still important to know about risk factors that cannot be changed, because it's even more important for women who have these factors to get regular Pap tests to detect cervical cancer early.

Cervical cancer risk factors include:

Human papilloma virus infection

The most important risk factor for cervical cancer is infection by the human papilloma virus (HPV). HPV is a group of more than 100 related viruses that can infect cells on the surface of the skin, genitals, anus, mouth and throat. They are called papilloma viruses because some of them cause a type of growth called a papilloma. Papillomas are not cancers, and are more commonly called warts. HPV is passed from one person to another during skin-to-skin contact. HPV can be spread during sex - including vaginal intercourse, anal intercourse, and even during oral sex. Still, intercourse doesn't have to take place for HPV to spread from one person to another. All that is needed is for there to be skin-to-skin contact with an area of the body infected with HPV.

Doctors believe that women must be infected by HPV before they develop cervical cancer. Certain types of HPV are called high-risk types because they are often the cause of cancer of the cervix. These types include HPV 16, HPV 18, HPV 31, HPV 33, and HPV 45, as well as some others. About two-thirds of all cervical cancers are caused by HPV 16 and 18. The high-risk types are also associated with other anogenital cancers such as vulvar and vaginal cancer in women, penile cancer in men, and anal cancer in both men and women.

Different types of HPVs cause warts on different parts of the body. Some types cause common warts on the hands and feet. Other types tend to cause warts on the lips or tongue. HPV only infects cells on the surface of the body, including those of the anus and genitals, but cannot infect the blood or most internal organs such as the heart or lungs.

Still other types of HPV may cause warts on or around the female and male genital organs and in the anal area. These warts may barely be visible or they may be several inches across. These are known as genital warts or condyloma acuminatum. HPV 6 and HPV 11 are the 2 types of HPV that cause most cases of genital warts. Since these 2 types are seldom linked to cervical cancer, they are called low-risk types of HPV.

Many women become infected with HPV, but very few will ever develop cervical cancer. In most cases the body's immune system fights off the virus, and the infection goes away without any treatment. For reasons that we don't understand, in some women the infection persists and can go on to cause cervical cancer. Although there is currently no cure for HPV infection, there are ways to treat the warts and abnormal cell growth that HPV causes.

The Pap test looks for changes in cervical cells caused by HPV infection. Newer tests look for the infections themselves by finding genes (DNA) from HPV in the cells. Some doctors use the test for HPV to help decide what to do when a woman has a mildly abnormal Pap test result. If the test finds a high-risk type of HPV, it may mean she will need a full evaluation with a colposcopy procedure.

HPV infections occur mainly in young women and are less common in women older than 30. The reason for this is not clear. Uncircumcised men are thought to be more likely to have the virus and be able to pass it on to someone else. HPV infection can be present for years without any symptoms. Even when someone doesn't have visible warts (or any other symptom), he or she can still be infected with HPV and pass the virus to somebody else.

Condoms ("rubbers") do provide some protection against HPV, but they cannot completely protect against infection. This is because HPV can still be passed from one person to another by skin-to-skin contact with an HPV-infected area of the body that is not covered by a condom - like the skin in the genital or anal area. Still, condoms can help the body get rid of an HPV infection faster, so that abnormal pap tests become normal again in less time. Also, it is important to use condoms to protect against AIDS and other sexually transmitted illnesses that are passed on through some body fluids.

Vaccines have been developed to help prevent infection with some types of HPV. Right now, 2 different HPV vaccines have been approved for use in the United States by the Food and Drug Administration (FDA). One vaccine is called Gardasil^®, and it protects against HPV types 6, 11, 16, and 18. Another HPV vaccine, known as Cervarix^®, protects against HPV types 16 and 18. Both of these vaccines have been shown to reduce the risk of cervical cancer. More HPV vaccines are being developed and tested.

Although it is necessary to have HPV for cervical cancer to develop, most women with this virus do not develop cancer. Doctors believe that other factors must come into play for cancer to develop. Some of the known factors are listed below.

Smoking

Women who smoke are about twice as likely as non-smokers to get cervical cancer. Smoking exposes the body to many cancer-causing chemicals that affect organs other than the lungs. These harmful substances are absorbed through the lungs and carried in the bloodstream throughout the body. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cervix cells and may contribute to the development of cervical cancer.

Immunosuppression

Human immunodeficiency virus (HIV), the virus that causes AIDS, damages the body's immune system and places women at higher risk for HPV infections. This may explain the increased risk of cervical cancer for women with AIDS. Scientists believe that the immune system is important in destroying cancer cells and slowing their growth and spread. In women with HIV, a cervical pre-cancer might develop into an invasive cancer faster than it normally would.

Chlamydia infection

Chlamydia is a relatively common kind of bacteria that can infect the reproductive system. It is spread by sexual contact. Chlamydia infection can cause pelvic inflammation, leading to infertility. Some studies have seen a higher risk of cervical cancer in women whose blood test results show evidence of past or current chlamydia infection (compared with women who have normal test results). Infection with chlamydia often causes no symptoms in women. A woman may not know that she is infected at all unless she is tested for chlamydia when she gets her pelvic exam.

Diet

Women with diets low in fruits and vegetables may be at increased risk for cervical cancer. Also overweight women are more likely to develop adenocarcinoma of the cervix.

Oral contraceptives (birth control pills)

There is evidence that taking oral contraceptives (OCs) for a long time increases the risk of cancer of the cervix. Research suggests that the risk of cervical cancer goes up the longer a woman takes OCs, but the risk goes back down again after the OCs are stopped. In a recent study, the risk of cervical cancer was doubled in women who took birth control pills longer than 5 years, but the risk returned to normal 10 years after they were stopped.

The American Cancer Society believes that a woman and her doctor should discuss whether the benefits of using OCs outweigh the potential risks. A woman with multiple sexual partners should use condoms to lower her risk of sexually transmitted illnesses no matter what other form of contraception she uses.

Multiple full-term pregnancies

Women who have had 3 or more full-term pregnancies have an increased risk of developing cervical cancer. No one really knows why this is true. One theory is that these women had to have had unprotected intercourse to get pregnant, so they may have had more exposure to HPV. Also, studies have pointed to hormonal changes during pregnancy as possibly making women more susceptible to HPV infection or cancer growth. Another thought is that the immune system of pregnant women might be weaker, allowing for HPV infection and cancer growth.

Young age at the first full-term pregnancy

Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older.

Poverty

Poverty is also a risk factor for cervical cancer. Many women with low incomes do not have ready access to adequate health care services, including Pap tests. This means they may not get screened or treated for cervical pre-cancers.

Diethylstilbestrol (DES)

DES is a hormonal drug that was given to some women to prevent miscarriage between 1940 and 1971. Women whose mothers took DES (when pregnant with them) develop clear-cell adenocarcinoma of the vagina or cervix more often than would normally be expected. This type of cancer is extremely rare in non-DES exposed women. There is about 1 case of this type of cancer in every 1,000 women whose mothers took DES during pregnancy. This means that about 99.9% of "DES daughters" do not develop these cancers.

DES-related clear cell adenocarcinoma is more common in the vagina than the cervix. The risk appears to be greatest in women whose mothers took the drug during their first 16 weeks of pregnancy. The average age of women when they are diagnosed with DES-related clear-cell adenocarcinoma is 19 years. Since the use of DES during pregnancy was stopped by the FDA in 1971, even the youngest DES daughters are older than 35 - past the age of highest risk. Still, there is no age cut-off when these women are safe from DES-related cancer. Doctors do not know exactly how long women will remain at risk.

DES daughters may also be at increased risk of developing squamous cell cancers and pre-cancers of the cervix linked to HPV.

Family history of cervical cancer

Cervical cancer may run in some families. If your mother or sister had cervical cancer, your chances of developing the disease are 2 to 3 times higher than if no one in the family had it. Some researchers suspect that some instances of this familial tendency are caused by an inherited condition that makes some women less able to fight off HPV infection than others. In other instances, women from the same family as a patient already diagnosed may be more likely to have one or more of the other non-genetic risk factors previously described in this section.

Last Medical Review: 09/14/2009
Last Revised: 01/19/2010