Abstract
Globally cervical cancer is one of the commonest cancers in women. It comprises approximately 12% of all cancers and is the commonest cancer in women in developing countries. The most recent compilation of global data indicates that an estimated 490 000 new cases of cervical cancer occur annually worldwide and nearly 80% of these are in developing countries, where screening programmes are not well established and are poorly organised. Cervical cancer is the leading cause of cancer death among women. It is estimated that 270 000 women die annually from cervical cancer, 85% of them in low-resource nations.1-3 In Africa, cervical cancer comprises 23.3% of all cancers in women.4 According to the South African National Cancer Registry (NCR) data, the lifetime risk for the development of cervical cancer in 1998 was 1 in 26 for South African women and 1 in 21 for black South African women.5 These are believed to be minimal rates, as the registry publishes only data collected from the pathology laboratories and is not a population-based cancer registry. HIV/ AIDS poses a severe threat to global health. In addition, the HIV epidemic has hit hardest in regions of high prevalence of cervical dysplasia and cancer. The HIV epidemic in South Africa is one of the worst in the world. The prevalence of HIV among South African women attending antenatal clinics in 2006 was 29.1%.6 With improved access to antiretroviral therapy, women are expected to live longer as the risk of death from opportunistic infections decreases. It is assumed that the incidence of cervical cancer and the prevalence of precursor lesions will increase, especially in countries that lack well-organised cervical screening. However, this remains to be seen.
Highlights
Cervical cancer is one of the commonest cancers in women
Cervical cancer and its precursor lesions are caused by infection with the human papillomavirus (HPV)
Within the cervix HPV most commonly infects the mitotically active transformation zone at the squamo-columnar junction, which explains in part why HPV is associated with both squamous and glandular neoplasia
Summary
Cervical cancer and its precursor lesions are caused by infection with the human papillomavirus (HPV). The papillomavirus is an obligatory intranuclear virus that must infect mitotically active cells to institute infection. HPV viruses of the anogenital tract are divided into ‘low-risk’ and ‘high-risk’ types depending on their ability to produce neoplasia.[7,8] There are a variety of opinions on how the human papillomavirus types should be classified. Persistent HPV infection is the first step towards cervical dysplasia and cancer. Factors that may increase the risk of persistent infection and cell dysregulation include immune suppression, cigarette smoke, multiple sexual partners, age of first intercourse, hormonal birth control and possibly other sexually transmitted infections such as Chlamydia.[7,8]
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