1. Predisposing Factors/Risk Factors - BC Cancer

Known Risk Factors. Human papillomavirus (HPV): HPV is the most common sexually transmitted disease and is the major factor causally associated with ... 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PageContentUpdatedDecember2021Canceroftheuterinecervixisthe13thmostcommoncancerinCanadianwomen,withanestimated1500newdiagnosesin2016. About400womenwilldiefromthediseaseperyear. Themostcommonhistologictypesofcervicalcanceraresquamouscellcarcinomas,whichariseintheectocervix(70%),andadenocarcinomasoradenosquamouscarcinomasarisingintheendocervicalcanal(25%).  KnownRiskFactorsHumanpapillomavirus(HPV):HPVisthemostcommonsexuallytransmitteddiseaseandisthemajorfactorcausallyassociatedwithcervicalcancer.HPVisagroupofmorethan100differenttypesofviruses,ofwhichatleast13typesareknowncarcinogens.HPV-16and-18cause70%ofthecervicalcancersandprecancerouscervicallesions4.High-riskgroupsincludewomenwhohavelessaccesstoPaptestsorwomenwhohaveneverparticipatedinscreeningprograms.Smoking:womenwhosmokeareatincreasedriskofdevelopingcervicalcancer.Tobaccoby-productsmaycontributetocervicalcancerbyeitherlocalDNAdamageorlocalimmunosuppressionandreducedimmuneresponsetoHPVinfection5. Humanimmunodeficiencyvirus(HIV):HIVinfectioninwomenappearstoelevateriskofcervicalcancerduetoimmunosuppression6.Diethylstilbestrol(DES):thisisaformofestrogenthatwasusedfrom1940to1971fortreatmentofcertainconditionsduringpregnancysuchasmiscarriages.Daughtersofwomenwhotookthismedicationduringtheirpregnancyareathigherriskofdevelopingclearcellcarcinomaofcervixorvagina.DESdaughtersmayalsobeatincreasedriskofcervicalsquamouscellcarcinomadevelopmentiftheyhadexposuretoHPV. PossibleRiskFactorsSexuallytransmittedinfections:somestudiesdemonstratedhigherriskofcervicalsquamouscellcancerwithpastorcurrentchlamydiaorherpessimplexvirustype2infections8.Moreresearchisrequiredtoclarifytheroleoftheseinfectionsforcervicalcancer.Familyhistoryofcervicalcancer:thereissomeevidencethatwomenwithfamilyhistoryofcervicalcancerhavehigherchanceofcervicalcancerdiagnosiscomparedtowomenwithoutafamilyhistory9.However,morestudiesarerequiredtoclarifywhetherthisisduetogeneticsorhavinghighermotivationforscreeningandhealthprotectivebehaviors.Obesity:observationalstudiesreportednoassociationbetweencervicalcancerandbeingoverweight.Butobesitywasweaklyassociatedwithanincreasedriskofcervicalcancer10.Moreresearchisrequiredtoprovideconclusiveevidenceinthisregard.PreventionHPVvaccines:thesevaccinesarepowerfultoolstodiminishtherateofHPV-associatedcancersincludingcervical,oropharyngeal,anal,vulvar,vaginalandpenilemalignancies.ThreeHPVvaccineshavebeendevelopedandapprovedforusebyHealthCanada:Cervarix®(HPV2) [againstHPVtypes16and18]Gardasil®(HPV4) [HumanPapillomavirusquadrivalent(againstHPVtypes6,11,16,18)]Gardasil®9(HPV9)  [HumanPapillomavirusnonavalent(againstHPVtypes6,11,16,18,31,33,45,52and58)]. All3vaccinesprotectagainstthe2typesofHPVthatcauseabout70%ofcasesofcervicalcancer. TheHPV9vaccineprotectsagainst5additionaltypesofHPVthatcauseabout15%to20%ofcervicalcancers. TheHPV4andHPV9vaccinesalsoprotectagainst2typesofHPVthatcauseabout90%ofcasesofgenitalwarts. Vaccinationisrecommendedforgirlsandwomenbetweentheagesof9and45yearsbeforetheycomeincontactwithHPV. ThevaccinemayalsobenefitwomenwhoaresexuallyactiveandhavenotyetbeeninfectedwithHPV.  InBritishColumbia,theHPV9vaccineisrecommendedandprovidedfreetogirlsingrade6. InSeptember2016,theHPV9vaccinereplacedtheHPV4vaccinewhichwaspreviouslyprovidedaspartoftheschool-basedimmunizationprogram.TheHPV9vaccineisalsoprovidedfreetofemaleswhoare9to26yearsofageorinfectedwithHIV.SinceSeptember2017,BC'spubliclyfundedimmunizationprogramincludestheHPV9vaccineforgrade6boys. Therefore,allgrade6studentsinBC,bothfemaleandmale,areofferedtheHPV9vaccineseriesforfreeaspartoftheregularschool-basedimmunizationprogram. FormoreinformationpleaserefertotheMinistryofHealthannouncement:B.C.extendsfreeHPVcoveragetoboys.TheHPV4vaccineisrecommendedandprovidedfreetogirlsandyoungwomenbornin1994to2004whohavenotreceivedthevaccine. GirlsandyoungwomeninthisagegroupwhomissedgettingtheHPV4vaccinecancontacttheirhealthcareprovidertogetimmunizedatnocost.TheHPV4vaccineisalsofreeformaleswhoareatanincreasedriskforHPVinfection. Thisincludesmaleswhoare:9to26yearsofage(inclusive)andhavesexwithmen(orwhoarenotyetsexuallyactivebutquestioningtheirsexualorientation),arestreetinvolved,orareHIVpositive.9to18yearsofageinthecareoftheMinistryofChildrenandFamilyDevelopment. Inyouthcustodyservicescentres. FormoreinformationoneligibilityforfreeHPVvaccine,pleasevisitImmunizeBC.ThosewhoarenoteligibleforfreeHPVvaccinecanpurchaseitatmostpharmacies,travelclinics,andsomesexualhealthclinics. VaccinationpreventsHPVinfectionbutdoesnotgetridofitoncetheinfectionoccurs. IndividualswhohavereceivedtheHPVvaccinestillrequirecervicalcancerscreening. ThevaccinedoesnotprotectagainstalltypesofHPVthatcancausecanceranditalsodoesnotpreventothersexuallytransmittedinfections.Vaccinationissafe,veryeffective,andhasfewsideeffects. Formoreinformation,pleasecallyourlocalPublicHealthUnitorspeaktoyourfamilyphysician.  ReferencesCanadianCancerSociety(http://www.cancer.ca/en/cancer-information/cancer-type/cervical/statistics/?region=on#ixzz4dJJSN4Fwnewcasesin2016)  http://www.bccancer.bc.ca/about/news-stories/news/2016/british-columbia-adopts-new-cervical-cancer-screening-policy(link)KelseyJ,WhittemoreAS.Epidemiologyandprimarypreventionofcancersofthebreast,endometriumandovary:abriefoverview.AnnEpidemiology1994;4:89-95. WHOreport-http://www.who.int/mediacentre/factsheets/fs380/en/Fonseca-Mourinhoetal.SmokingandCervicalCancer.ISRNObstandGyne,vol2011NCIreport-https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hiv-fact-sheet.IARCworkingGroupontheEvaluationofCarcinogenicRiskofCombinedEstrogen-ProgestogenContraceptivestoHumans.Vol91:1-528,2007.Madeleineetal.RiskofCervicalCancerAssociatedwithChlamydiatrachomatisAntibodiesbyHistology,HPVtype,andHPVCofactors.IntJCancer2007;120(3):650-655.Bellingeretal.TheRoleofFamilyHistoryofCanceronCervicalCancerScreeningBehaviorinaPopulation-BasedSurveyofWomenintheSoutheasternUnitedStates.-WomensHealthIssues;2003;23(4):e197-e204.Poorolajaletal.TheassociationbetweenBMIandcervicalcancerrisk:ameta-analysis.EurJCancerPrev.2016May;25(3):232-8. 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