Cervical cancer Risk factors, early detection and prevention

With over half a million new cases and more than 300,000 deaths per year, cervical cancer is the fourth most common cancer in women worldwide. Higher-grade cervical intraepithelial neoplasia (CIN 2/3) precedes cancer. Early diagnosis and treatment of these lesions can prevent the development of cancer. With the introduction of screening programs based on cytological smears, the incidence and mortality of cervical cancer has decreased by more than half over the last 50 years in high-income countries. It is therefore fair to say that the introduction of cytological screening is one of the most successful preventive medical interventions in medicine. High-risk subtypes of the human papillomavirus (HPV) are almost always the cause of cervical cancer and its precursor lesions. This knowledge has changed the concept of early detection to the extent that HPV testing now plays an important role in screening programs worldwide. In addition to high-risk HPV infection, other virus-independent risk factors must also be considered, albeit to a much lesser extent. These include immunodeficiency, multiparity, long-term use of oral contraceptives, and smoking. The development of cervical cancer is largely preventable. HPV vaccination of girls and boys before their first sexual contact could, with vaccination rates above 70%, make the disease a very rare event. However, because 90% of cervical cancers occur in low- and middle-income countries and due to the absence of opportunities to establish systematic screening programs, the implementation of comprehensive vaccination programs would also be a significant step forward here, as called for by the World Health Organization (WHO).