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INTRODUCTION

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Cervical cancer is one of the most common cancers in women worldwide. Nearly all invasive squamous cell carcinomas are preceded by persistent human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN), and vast improvements in screening over the last 60 years have dramatically lowered the incidence of invasive disease in the developed world. Localized and some advanced cervical cancers in the United States have excellent prognoses, yet in developing countries, this disease remains the most lethal malignancy in women.

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EPIDEMIOLOGY

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Key Points

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  1. Minority and low-socioeconomic status patients are still at risk for developing cervical cancer in the United States due to lack of screening and early treatment.

  2. The largest risk factor for cervical cancer is persistent HPV infection. Other risk factors include history of sexually transmitted diseases, multiple sexual partners, high parity, immunosuppression, and smoking.

  3. The HPV oncoproteins E6 and E7 bind and inactivate the tumor suppressor genes p53 and pRB, respectively, which contributes to cervical carcinogenesis.

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Incidence

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Cervical cancer is the third most common cancer in women worldwide, with more than 450,000 cases diagnosed annually. Developed countries have demonstrated a decreasing incidence and mortality from squamous cervical cancers over the last 50 years. This is likely due to improved access to screening, decreasing parity, and lower baseline prevalence of HPV. Adeno-carcinomas of the cervix account for approximately 15% of cervical cancers in the United States and have risen slightly over the last 20 to 30 years. The recent availability of an HPV vaccine has been shown to decrease the incidence of high-grade CIN and may further reduce the incidence of cervical cancer in years to come.1

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In 2010, the American Cancer Society estimates 12,200 new cases of cervical cancer in the United States, with 4210 women predicted to die from this disease. The peak incidence for this disease is 45 years. Although the overall incidence of cervical cancer is low in the United States, the incidence in African Americans is nearly 50% higher than in Caucasians, and the incidence in the Hispanic population is more than double that of Caucasians. Furthermore, in comparison with Caucasians. African Americans are more frequently diagnosed with advanced-stage tumors and are less likely to receive treatment.2

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Risk Factors

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Several established risk factors are known to contribute to cervical carcinogenesis. More than 99% of cervical cancers are associated with infection with HPV; risk factors associated with HPV infection are the same for CIN and cervical cancer. These include multiple sexual partners, history of other sexually transmitted infections, high parity, immunosuppression, and cigarette smoking.3 Obesity has been associated with a slightly increased risk of adenocarcinoma of the cervix.4 However, neither parity nor smoking has been associated with increased risk of adenocarcinoma of the cervix.5 Interestingly, although cervical cancer is not a typical genetically inherited ...

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