Cancer of the Cervix and of the womb

Causes

Cancer of the neck of the womb seems to be related to the sexual act, since the disease spares nuns and virgins but not nuns who joined their Orders later in life.

It is extremely rare in Jewish women, probably on account of their partners having been circumcised at birth which makes male genital cleanliness easier and reduces the risk of infection. It is uncommon in Parsees, perhaps because their religion is based on purity, which means that they practice meticulous genital hygiene, an invaluable protective measure that is well-worth emulating.

The risk of developing cervical cancer increases with the number of marriages and with the number of extra-marital partners. It is most common in prostitutes. It is also related to the age at which regular sexual intercourse first takes place, the younger the woman, the greater the risk of contracting the disease. The risk is further increased by sexual promiscuity, especially in the teens', when the cervix is vulnerable to injury, and is further aggravated by having a venereal infection, particularly if early in life.

There is increasing evidence that the use of barrier contraceptives, sheath or diaphragm (cap), is of great protective value, because the disease is apparently of venereal origin, due to sexually transmitted infection of either the genital herpes virus 11 or one of the many types of human papilloma virus responsible for genital warts, which is usually passed from the infected, uncircumcised male during intercourse. Its infectious origin is proved by the fact that the risk of developing the disease depends as much on the number of partners the woman's partner has had, as on the number she has had herself.

The infection tends to occur together in husband and wife and will probably be found to cause the much rarer cancer of the penis. This form of cancer can permanently be prevented by circumcision at birth.

The occurrence of genital warts has doubled in frequency in the past eight years, as has the frequency of cancerous lesions of the cervix, especially in young women.

There are two complicating factors:

• The herpes simplex 11 virus is known to be directly associated with an increased incidence of cancer of the cervix.
• Smoking has been shown to increase the proneness to the disease in infected cases.

It is thought that cancer of the cervix may arise as a result of the herpes simplex 11 virus with the human papilloma virus (or, alternatively, nicotine) as the promoter.

The fact that invasive cervical cancer occurs more frequently in oral contraceptive users can be explained on hormonal grounds. The contraceptive hormones increase the reproduction rate of the virus, stimulating the infectious process. That hormones increase the size of genital warts can be seen during pregnancy.

Prevention

• Use a barrier contraceptive
• Practice meticulous genital cleanliness - have a hot bath and wash thoroughly after sex
• Delay sex until your late teens and limit your number of sexual partners
• Have a regular cervical smear test every 2 years
• Cut down on or quit smoking

The current frequency of human papilloma virus infection makes two-yearly cervical smears essential, particularly in young women who smoke and are on oral contraceptives.

Cancer of the cervix still kills 4,600 women in the United States and some 2,000 women in Britain each year and more than twice as many under the age of 35 than it did 15 years ago. This may be a reflection on the earlier age at which regular sexual intercourse is started these days in a permissive society where the contraceptive pill, being ready available, encourages this behaviour.

In Iceland where practically all women are screened every 2-3 years the incidence of cervical cancer has dropped by two-thirds, whereas in Norway, where only five per cent are screened it has risen by one-sixth. The UK has a similar programme to that in Norway. At present only the better educated British women seem to attend regularly for screening, yet it is the poorer social classes who, having a much higher incidence of cervical cancer (possibly due to a lower standard of genital hygiene), are at greater risk and who would benefit most by regular screening.

It is estimated that the availability of a regular cervical smear test (called a Pap smear after its originator Dr Papanicolaus) for all young women every two years would reduce the current cervical death rate by half. Even so, more lives would be saved by giving up smoking. The follow-up study of women who refused treatment after abnormalities of the cervix were detected, has proved the great preventive value of the Pap smear.