Cervical Cancer
CancerIndex Home - Cancer UK UK-Menu > Cancer Types > Cervical Cancer

Cervical cancer is a common type of malignancy accounting for about 6% of all cancers found in women. It is a disease in which cancerous cells develop in the uterine cervix (this is the connecting passage between the uterus and vagina). The human papillomaviruses (HPV) are the principal cause of most cervical cancers. The peak incidence of cervical cancer occurs between the ages of 40 to 55. It is rare before the age of 35, however the incidence of cervical cancer in younger women rose dramatically during the two decades after 1960. Regular Pap smear tests may detect abnormal changes in the cervical tissues, before cancer develops. Symptoms of cervical cancer may include vaginal bleeding after intercourse or bleeding between periods. However, in the early stages of the disease there are often no obvious signs or symptoms, so regular smear tests are important.

In the UK about 2,800 women are diagnosed with cervical cancer each year. (Source: Cancer Research UK)

This page shows only UK resources. For a more extensive list of resources from around the world see CancerIndex: Cervical Cancer

Menu: Cervical Cancer

Information for Patients and the Public
Information for Health Professionals / Researchers
Latest Research Publications

Information Patients and the Public (12 links)


Information for Health Professionals / Researchers (5 links)

Latest Research Publications

Showing publications with corresponding authors from the UK (Source: PubMed).

Hall JS, Iype R, Armenoult LS, et al.
Poor prognosis associated with human papillomavirus α7 genotypes in cervical carcinoma cannot be explained by intrinsic radiosensitivity.
Int J Radiat Oncol Biol Phys. 2013; 85(5):e223-9 [PubMed]
PURPOSE: To investigate the relationship between human papillomavirus (HPV) genotype and outcome after radiation therapy and intrinsic radiosensitivity.
METHODS AND MATERIALS: HPV genotyping was performed on cervix biopsies by polymerase chain reaction using SPF-10 broad-spectrum primers, followed by deoxyribonucleic acid enzyme immunoassay and genotyping by reverse hybridization line probe assay (LiPA25) (version 1) (n=202). PapilloCheck and quantitative reverse transcription-polymerase chain reaction were used to genotype cervix cancer cell lines (n=16). Local progression-free survival after radiation therapy alone was assessed using log-rank and Cox proportionate hazard analyses. Intrinsic radiosensitivity was measured as surviving fraction at 2 Gy (SF2) using clonogenic assays.
RESULTS: Of the 202 tumors, 107 (53.0%) were positive for HPV16, 29 (14.4%) for HPV18, 9 (4.5%) for HPV45, 23 (11.4%) for other HPV genotypes, and 22 (10.9%) were negative; 11 (5.5%) contained multiple genotypes, and 1 tumor was HPV X (0.5%). In 148 patients with outcome data, those with HPVα9-positive tumors had better local progression-free survival compared with α7 patients in univariate (P<.004) and multivariate (hazard ratio 1.54, 95% confidence interval 1.11-1.76, P=.021) analyses. There was no difference in the median SF2 of α9 and α7 cervical tumors (n=63). In the cell lines, 9 were α7 and 4 α9 positive and 3 negative. There was no difference in SF2 between α9 and α7 cell lines (n=14).
CONCLUSION: The reduced radioresponsiveness of α7 cervical tumors is not related to intrinsic radiosensitivity.
Translational Radiobiology Group, Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester
Research funded by:


Cuzick J, Bergeron C, von Knebel Doeberitz M, et al.
New technologies and procedures for cervical cancer screening.
Vaccine. 2012; 30 Suppl 5:F107-16 [PubMed]
The clearly higher sensitivity and reproducibility of human papillomavirus (HPV) DNA testing for high-grade cervical intraepithelial neoplasia (CIN) has led to widespread calls to introduce it as the primary screening test. The main concern has been its lower specificity, due to the fact that it cannot separate transient from persistent infections, and only the latter are associated with an increased risk of high-grade CIN and cancer. Thus, even proponents of HPV testing generally only recommend it for women over the age of 30 years (or in some cases 35 years). If HPV testing is to reach its full potential, new approaches with better specificity are needed, either as triage tests for HPV positive women or, if the high sensitivity of HPV DNA testing can be maintained, as alternate primary screening modalities. Approaches that may useful in this regard, especially as triage tests, include HPV typing, methylation (and consequent silencing) of host and viral genes, and new cytologic methods, such as p16(INK4a) staining, which attempt to identify proliferating cells. At an earlier stage of development are direct methods based on detection of HPV E6 or E7 proteins. Recent progress and current status of these methods is discussed in this chapter. The current status of visual inspection (VIA and VILI) methods is also surveyed and progress on self-sampling is reviewed. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
Wolfson Institute of Preventive Medicine, Queen Mary University of London, London


Osborn DP, Horsfall L, Hassiotis A, et al.
Access to cancer screening in people with learning disabilities in the UK: cohort study in the health improvement network, a primary care research database.
PLoS One. 2012; 7(8):e43841 [PubMed] Free Access to Full Article
OBJECTIVES: To assess whether people with learning disability in the UK have poorer access to cancer screening.
DESIGN: Four cohort studies comparing people with and without learning disability, within the recommended age ranges for cancer screening in the UK. We used Poisson regression to determine relative incidence rates of cancer screening.
SETTING: The Health Improvement Network, a UK primary care database with over 450 General practices.
PARTICIPANTS: Individuals with a recorded diagnosis of learning disability including general diagnostic terms, specific syndromes, chromosomal abnormalities and autism in their General Practitioner computerised notes. For each type of cancer screening, a comparison cohort of up to six people without learning disability was selected for each person with a learning disability, using stratified sampling on age within GP practice.
MAIN OUTCOME MEASURES: Incidence rate ratios for receiving 1) a cervical smear test, 2) a mammogram, 3) a faecal occult blood test and 4) a prostate specific antigen test.
RESULTS: Relative rates of screening for all four cancers were significantly lower for people with learning disability. The adjusted incidence rate ratios (95% confidence intervals) were Cervical smears: Number eligible with learning disability = 6,254; IRR = 0.54 (0.52-0.56). Mammograms: Number eligible with learning disability = 2,956; IRR = 0.76 (0.72-0.81); Prostate Specific Antigen: Number eligible = 3,520; IRR = 0.87 (0.80-0.96) and Faecal Occult Blood Number eligible = 6,566; 0.86 (0.78-0.94). Differences in screening rates were less pronounced in more socially deprived areas. Disparities in cervical screening rates narrowed over time, but were 45% lower in 2008/9, those for breast cancer screening appeared to widen and were 35% lower in 2009.
CONCLUSION: Despite recent incentives, people with learning disability in the UK are significantly less likely to receive screening tests for cancer that those without learning disability. Other methods for reducing inequalities in access to cancer screening should be considered.
Mental Health Sciences Unit, University College London, London
Research funded by:


Ekeowa-Anderson AL, Purdie KJ, Gibbon K, et al.
AKT1 loss correlates with episomal HPV16 in vulval intraepithelial neoplasia.
PLoS One. 2012; 7(6):e38608 [PubMed] Free Access to Full Article
Anogenital malignancy has a significant association with high-risk mucosal alpha-human papillomaviruses (alpha-PV), particularly HPV 16 and 18 whereas extragenital SCC has been linked to the presence of cutaneous beta and gamma-HPV types. Vulval skin may be colonised by both mucosal and cutaneous (beta-, mu-, nu- and gamma-) PV types, but there are few systematic studies investigating their presence and their relative contributions to vulval malignancy. Dysregulation of AKT, a serine/threonine kinase, plays a significant role in several cancers. Mucosal HPV types can increase AKT phosphorylation and activity whereas cutaneous HPV types down-regulate AKT1 expression, probably to weaken the cornified envelope to promote viral release. We assessed the presence of mucosal and cutaneous HPV in vulval malignancy and its relationship to AKT1 expression in order to establish the corresponding HPV and AKT1 profile of normal vulval skin, vulval intraepithelial neoplasia (VIN) and vulval squamous cell carcinoma (vSCC). We show that HPV16 is the principle HPV type present in VIN, there were few detectable beta types present and AKT1 loss was not associated with the presence of these cutaneous HPV. We show that HPV16 early gene expression reduced AKT1 expression in transgenic mouse epidermis. AKT1 loss in our VIN cohort correlated with presence of high copy number, episomal HPV16. Maintained AKT1 expression correlated with low copy number, an increased frequency of integration and increased HPV16E7 expression, a finding we replicated in another untyped cohort of vSCC. Since expression of E7 reflects tumour progression, these findings suggest that AKT1 loss associated with episomal HPV16 may have positive prognostic implications in vulval malignancy.
Centre for Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London
Research funded by:


Cairns M, Tidy J, Cruickshank ME
Management of microinvasive cervical cancer: a British Society for Colposcopy and Cervical Pathology audit.
J Low Genit Tract Dis. 2012; 16(4):403-8 [PubMed]
UNLABELLED: The incidence of microinvasive cervical cancers seems to be increasing as a result of screening. However, there is little national or international guidance on best management or follow-up of women treated with conservation of the cervix.
OBJECTIVE: The study aimed to assess the current management and follow-up of women with stage IA cervical cancer, according to the International Federation of Gynecology and Obstetrics, within the United Kingdom.
DESIGN/SETTING: This study is a multicenter national audit of a clinical practice in the United Kingdom.
MATERIALS AND METHODS: A structured questionnaire was sent and returned electronically to all lead colposcopists in the United Kingdom on the management and follow-up of women with stage IA cervical cancer according to the International Federation of Gynecology and Obstetrics. The study was approved by the British Society for Colposcopy and Cervical Pathology.
RESULTS: Of the 210 lead colposcopists, 110 (52%) responded. All reported that women with stage IA cervical cancer are discussed at a gynecologic multidisciplinary team meeting. Women who managed conservatively with their cervix in situ are followed up for at least 5 years. There is a wide variation in clinical management of cases with lymphovascular space involvement (LVSI) and depth of invasion greater than 3 mm (stage IA2).
CONCLUSIONS: The pattern and practice of follow-up for stage IA cervical cancer is highly variable. The development of national guidance should be considered.
Department of Gynaecological Oncology, Aberdeen Royal Infirmary, Scotland


Devaja O, Mehra G, Coutts M, et al.
A prospective single-center study of sentinel lymph node detection in cervical carcinoma: is there a place in clinical practice?
Int J Gynecol Cancer. 2012; 22(6):1044-9 [PubMed]
OBJECTIVE: To establish the accuracy of sentinel lymph node (SLN) detection in early cervical cancer.
MATERIALS AND METHODS: Sentinel lymph node detection was performed prospectively over a 6-year period in 86 women undergoing surgery for cervical carcinoma by the combined method (Tc-99m and methylene blue dye). Further ultrastaging was performed on a subgroup of 26 patients who had benign SLNs on initial routine histological examination.
RESULTS: The SLN was detected in 84 (97.7%) of 86 women by the combined method. Blue dye uptake was not seen in 8 women (90.7%). Sentinel lymph nodes were detected bilaterally in 63 women (73.3%), and the external iliac region was the most common anatomic location (48.8%). The median SLN count was 3 nodes (range, 1-7). Of the 84 women with sentinel node detection, 65 also underwent bilateral pelvic lymph node dissection, and in none of these cases was a benign SLN associated with a malignant non-SLN (100% negative predictive value). The median non-SLN count for all patients was 19 nodes (range, 8-35). Eighteen patients underwent removal of the SLN without bilateral pelvic lymph node dissection. Nine women (10.5%) had positive lymph nodes on final histology. One patient had bulky pelvic nodes on preoperative imaging and underwent removal of the negative bulky malignant lymph nodes and a benign SLN on the contralateral side. This latter case confirms the unreliability of the SLN method with bulky nodes. The remaining 8 patients had positive SLNs with negative nonsentinel lymph nodes. Fifty-nine SLNs from 26 patients, which were benign on initial routine histology, underwent ultrastaging, but no further disease was identified. Four patients (5%) relapsed after a median follow-up of 28 months (range, 8-80 months).
CONCLUSION: Sentinel lymph node detection is an accurate and safe method in the assessment of nodal status in early cervical carcinoma.
Department of Gynaecological Oncology, Maidstone Hospital, Kent Oncology Centre, Maidstone, Kent


Bailey H, Thorne C, Semenenko I, et al.
Cervical screening within HIV care: findings from an HIV-positive cohort in Ukraine.
PLoS One. 2012; 7(4):e34706 [PubMed] Free Access to Full Article
INTRODUCTION: HIV-positive women have an increased risk of invasive cervical cancer but cytologic screening is effective in reducing incidence. Little is known about cervical screening coverage or the prevalence of abnormal cytology among HIV-positive women in Ukraine, which has the most severe HIV epidemic in Europe.
METHODS: Poisson regression models were fitted to data from 1120 women enrolled at three sites of the Ukraine Cohort Study of HIV-infected Childbearing Women to investigate factors associated with receiving cervical screening as part of HIV care. All women had been diagnosed as HIV-positive before or during their most recent pregnancy. Prevalence of cervical abnormalities (high/low grade squamous intraepithelial lesions) among women who had been screened was estimated, and associated factors explored.
RESULTS: Overall, 30% (337/1120) of women had received a cervical screening test as part of HIV care at study enrolment (median 10 months postpartum), a third (115/334) of whom had been tested >12 months previously. In adjusted analyses, women diagnosed as HIV-positive during (vs before) their most recent pregnancy were significantly less likely to have a screening test reported, on adjusting for other potential risk factors (adjusted prevalence ratio (APR) 0.62, 95% CI 0.51-0.75 p<0.01 for 1(st)/2(nd) trimester diagnosis and APR 0.42, 95% CI 0.28-0.63 p<0.01 for 3(rd) trimester/intrapartum diagnosis). Among those with a cervical screening result reported at any time (including follow-up), 21% (68/325) had a finding of cervical abnormality. In adjusted analyses, Herpes simplex virus 2 seropositivity and a recent diagnosis of bacterial vaginosis were associated with an increased risk of abnormal cervical cytology (APR 1.83 95% CI 1.07-3.11 and APR 3.49 95% CI 2.11-5.76 respectively).
CONCLUSIONS: In this high risk population, cervical screening coverage as part of HIV care was low and could be improved by an organised cervical screening programme for HIV-positive women. Bacterial vaginosis testing and treatment may reduce vulnerability to cervical abnormalities.
MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London
Research funded by:


Isaacson Wechsler E, Wang Q, Roberts I, et al.
Reconstruction of human papillomavirus type 16-mediated early-stage neoplasia implicates E6/E7 deregulation and the loss of contact inhibition in neoplastic progression.
J Virol. 2012; 86(11):6358-64 [PubMed] Free Access to Full Article
Infection with human papillomavirus type 16 (HPV-16) can lead to low- or high-grade squamous intraepithelial lesions (LSIL or HSIL). Here we show that these in vivo disease states can be replicated in raft cultures of early-pass HPV-16 episomal cell lines, at both the level of pathology and the level of viral gene expression. A reduced responsiveness to cell-cell contact inhibition and an increase in E6/E7 activity correlated closely with phenotype. Similar deregulation is likely to underlie the appearance of LSIL or HSIL soon after infection.
Division of Virology, National Institute for Medical Research, London


Albrow R, Kitchener H, Gupta N, Desai M
Cervical screening in England: the past, present, and future.
Cancer Cytopathol. 2012; 120(2):87-96 [PubMed]
Cervical screening in England commenced in a disorganized fashion in 1964. The flaws of this approach became apparent in the mid-1980s and led to the inception of the National Health Service Cervical Screening Programme (NHSCSP). The main features of this program are its population-based registry, accessibility to all women within the screening age range, its systematic process of call and recall, national coordination, and quality assurance. Its success is in part based on its ability to evolve as evidence necessitates, and throughout the period of 2000-2010, it embarked upon a series of developments involving liquid-based cytology, which also provided the means to conduct reflex high-risk human papillomavirus (HR-HPV) testing and the potential to automate the screening process. As a result of evidence acquired since 2000, the NHSCSP is currently based on a system of primary cytology with HPV triage for low-grade abnormalities combined with cytology plus a HR-HPV "test of cure" for women who have received treatment for cervical intraepithelial neoplasia. Future challenges for the program will involve finding solutions to increasing screening uptake among women <30 years of age-a problem that may be exacerbated when vaccinated women reach the screening age, while making plans to accommodate HPV primary screening.
School of Cancer and Enabling Sciences, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester


Ragupathy K, Ndumbe F
Double cervical ostia after large loop excision of transformation zone.
J Low Genit Tract Dis. 2012; 16(3):330-2 [PubMed]
BACKGROUND: Large loop excision of the transformation zone (LLETZ) is the preferred treatment modality among colposcopists for cervical intraepithelial neoplasia. We report a unique case of cervical septum after LLETZ and the subsequent management.
CASE: Large loop excision of the transformation zone was performed on a young woman for a severely dyskaryotic cervical smear and colposcopic impression of high-grade abnormality. At her 6-month follow-up, double cervical ostium was seen resulting from cervical septum formation. This was surgically divided to enable a single cervical ostium for future smear taking and follow-up.
CONCLUSIONS: This case report is to make clinicians aware of a rare complication such as double cervical ostium after LLETZ and its management.
Department of Obstetrics and Gynaecology, Scunthorpe General Hospital, Scunthorpe


Basta NO, James PW, Craft AW, McNally RJ
Seasonality in the incidence of cervical carcinoma in teenagers and young adults in Northern England, 1968-2005.
Chronobiol Int. 2011; 28(9):819-24 [PubMed]
Infection with human papillomavirus is an established risk factor for cervical carcinoma. However, the role of other environmental factors is less well established. To further investigate whether other agents may be involved, the authors have analyzed seasonal variation in cervical cancer with respect to month of birth and separately month of diagnosis. All 85 cases diagnosed in 15-24-yr-olds during the period 1968-2005 were extracted from the specialist population-based Northern Region Young Persons' Malignant Disease Registry. The chi-square heterogeneity test was used to assess overall nonuniform variation in month of birth and separately month of diagnosis. Poisson regression analysis was used to fit sinusoidal (harmonic) models to the data using month of birth and month of diagnosis in separate models. Based on month of birth, there was statistically significant heterogeneity (p=.03) and a significant sinusoidal pattern, with an incidence peak involving births in the autumn months (p=.03). Based on month of diagnosis, there was marginally significant heterogeneity (p=.06). The evidence of seasonal variation around time of birth for cervical carcinoma is highly novel and suggests possible early etiological involvement of environmental factors.
Institute of Health and Society , Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, England


Vanni T, Luz PM, Grinsztejn B, et al.
Cervical cancer screening among HIV-infected women: an economic evaluation in a middle-income country.
Int J Cancer. 2012; 131(2):E96-104 [PubMed]
Due to the recent widespread availability of highly active antiretroviral therapy (HAART) in middle-income countries, there has been an increase in life expectancy for women on HAART, but no corresponding decrease in cervical cancer incidence. This study evaluates the optimal cervical cancer screening strategy for HIV-infected women in a middle-income country. We developed a mathematical model, which simulates the natural history of the HPV infection, as well as the HIV-mediated immunosupression among women in Brazil. Our model was calibrated using data from the IPEC/FIOCRUZ Women's HIV-infected cohort. The model compares the lifetime effects, costs and cost-effectiveness of strategies combining cytology, HPV DNA test and colposcopy at different screening intervals for different CD4 count strata (27 strategies in total). We found that the strategy with the best cost-effectiveness profile (cost-effectiveness ratio-U$4,911/year of life saved [YLS] and probability of being cost-effective-86%) was HPV testing followed by cytology triage every year for all HIV infected women, considering a very cost-effective threshold given by Brazil's GDP per capita (US$8,625/YLS). The results were robust to changes in the input parameters as demonstrated in one-way, scenario, threshold and probabilistic sensitivity analysis. Our study indicates that annual HPV testing followed by cytology triage for all HIV-infected women is likely to be very cost-effective in a middle-income country like Brazil. The results reflect the synergic effect of using a highly sensitive screening test (HPV DNA test) in sequence with a highly specific test (cytology).
Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London


Oladipo A, Sathiyathasan S, Thomas S, et al.
An unusual presentation of Wegener disease of the cervix: presenting as cervical cancer.
J Low Genit Tract Dis. 2011; 15(4):328-30 [PubMed]
OBJECTIVE: : Wegener granulomatosis is a rare autoimmune disease of unknown cause. It commonly affects the respiratory tracts, lungs, and kidneys.Involvement of the uterine cervix is rare, with only 4 previously published cases in the literature.
MATERIALS AND METHODS: : This is a case report.
RESULT: : We describe the unusual presentation of Wegener granulomatosis involving the uterine cervix, presenting as cervical cancer.
CONCLUSIONS: : A review of previously published cases of Wegener granulomatosis involving the uterine cervix is presented.We report the first case of Wegener granulomatosis involving the cervix without antecedent diagnosis or treatment of Wegener granuloma in any other organ.
Departments of Obstetrics and Gynaecology, Mayday University Hospital, Croydon, Surrey


Jones J, Saleem A, Rai N, et al.
Human Papillomavirus genotype testing combined with cytology as a 'test of cure' post treatment: the importance of a persistent viral infection.
J Clin Virol. 2011; 52(2):88-92 [PubMed]
BACKGROUND: Human Papillomavirus (HPV) testing has been evaluated as a test of cure in patients following treatment of high-grade cervical intraepithelial neoplasia (CIN2+). Studies show that women who are HPV and cytology negative post treatment can be safely returned to routine recall. The management strategy for HPV positive women requires confirmation.
OBJECTIVE: To evaluate the clinical utility of the PapilloCheck(®) genotyping assay for predicting disease recurrence in a test of cure setting.
STUDY DESIGN: Ninety-eight women (19-52 years) treated for CIN2+ by large loop excision of the transformation zone (LLETZ) were evaluated with samples taken before and 6 months after treatment for HPV testing. Cytology and histology were available from recruitment until 24 months post treatment.
RESULTS: Recurrent disease was evident in 4% of patients with 2 cases low-grade and 2 cases of high-grade disease. In women with no disease recurrence, 40% (95% CI 30.42-51.05%) were high risk (HR) HPV negative post LLETZ. Both cases with high-grade disease had persistent HPV16 infection. Genotyping before and after treatment revealed 83% (95% CI 75.74-88.78%) of total viral infections were cleared and 17% (95% CI 11.22-24.26) viral infections persisted. Post treatment, combined cytology and HPV test results predicted CIN2+ with 100% sensitivity, 91.7% specificity, 100% NPV and 20% PPV and measuring viral persistence marginally increased specificity and PPV.
CONCLUSION: Post treatment, cytology combined with a single HR HPV test has high sensitivity and specificity for predicting disease recurrence. HPV genotyping before and after LLETZ identifies persistent viral infections and could help refine patient management.
Department of Obstetrics & Gynaecology, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN


Louie KS, Castellsague X, de Sanjose S, et al.
Smoking and passive smoking in cervical cancer risk: pooled analysis of couples from the IARC multicentric case-control studies.
Cancer Epidemiol Biomarkers Prev. 2011; 20(7):1379-90 [PubMed]
BACKGROUND: The independent role of tobacco smoking in invasive cervical cancer (ICC) has been established. We evaluated the potential impact of passive smoking (PS).
METHODS: A pooled analysis of 1,919 couples enrolled in one of seven case-control studies involving cervical carcinoma in situ (CIS) or ICC was investigated. Information on smoking and sexual behavior was collected from interviews. Specimens were taken from the cervix and penis for human papillomavirus (HPV) DNA testing. Three PS risk models were constructed with all couples, couples with monogamous women, and couples with lifetime nonsmoking monogamous women. For the third model, the analysis considered potential misclassification of smoking status and was restricted to the risk period for which the woman was exposed to both HPV, a necessary cause of ICC, and PS. Multivariable unconditional logistic regression was used to estimate associations between CIS or ICC and PS.
RESULTS: An increased risk was found among couples with both ever smoking men and women (OR = 2.26; 95% CI: 1.40-3.64). No statistically increased risk of CIS was found with PS in the models analyzed. Similar significant increased risks of ICC with PS was found among all couples (OR = 1.57; 95% CI: 1.15-2.15) and couples with monogamous women (OR = 1.55; 95% CI: 1.07-2.23) but not among lifetime nonsmoking monogamous women married to ever smoking men.
CONCLUSION: PS could not be detected as an independent risk factor of ICC in the absence of active smoking.
IMPACT: The combined effects of exposure to active and PS suggest its potential adverse role in cervical carcinogenesis.
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London


Hilton S, Smith E
"I thought cancer was one of those random things. I didn't know cancer could be caught...": adolescent girls' understandings and experiences of the HPV programme in the UK.
Vaccine. 2011; 29(26):4409-15 [PubMed] Free Access to Full Article
BACKGROUND: The UK human papillomavirus (HPV) vaccination programme aims to provide girls aged 12-13 with protection against two of the most carcinogenic strains (types 16 and 18) of this sexually transmitted virus which together account for 70% of cases of cervical cancer. Despite evidence suggesting a general lack of knowledge about HPV and its link with cervical cancer, vaccine uptake rates were generally high in the UK for the first year of the HPV vaccination programme. In countries that implemented the HPV programme ahead of the UK, studies have found that girls' and parents' levels of awareness about HPV have increased since implementation of the programme but that knowledge continues to be limited. This study offers some of the first insights from the UK into adolescent girls' understandings of HPV, its link with cervical cancer, and experiences of vaccination, since the programme was introduced in September 2008.
METHOD: Eighteen focus groups were conducted between December 2009 and May 2010 with schoolgirls aged between 12 and 18 living in various parts of the UK.
RESULTS: Eighty seven girls participated in these discussions. Typically, girls knew very little about HPV or how they could best protect themselves from HPV infection. Although many of the girls linked HPV to cancer, only half specifically associated it with cervical cancer. Most girls had no idea how long the vaccine would offer them protection. They assumed that HPV vaccination must be important for their health because it was recommended by people they trusted, namely parents and immunisation experts. Just over half of the girls were aware that in the future they would need to attend for cervical screening. Key concerns which girls expressed about HPV vaccination reflected their anxieties about needles, anticipated pain on injection, privacy during vaccination and fears about needle cleanliness.
CONCLUSION: Our data point to a need to continue to address gaps in knowledge about HPV and to provide information to address girls' concerns about vaccination. This could be achieved through targeted campaign materials and by ensuring those involved in delivering the programme are aware of girls' anxieties to prevent limited knowledge and fears about vaccination becoming barriers either to HPV vaccination.
MRC Social & Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ
Research funded by:


Patel CN, Nazir SA, Khan Z, et al.
18F-FDG PET/CT of cervical carcinoma.
AJR Am J Roentgenol. 2011; 196(5):1225-33 [PubMed]
OBJECTIVE: This article outlines the role of FDG PET/CT in patients with cervical carcinoma for evaluating tumor extent, assessing treatment response, and detecting disease recurrence.
CONCLUSION: There is increasing evidence that FDG PET/CT has a role in the primary evaluation of cervical carcinoma-in particular, for evaluating lymph node status and distant metastatic disease. PET/CT is also helpful to determine prognosis, assess treatment response, and evaluate disease recurrence.
Department of Nuclear Medicine, St. James's University Hospital, Leeds


Beddy P, Rangarajan RD, Sala E
Role of MRI in intracavitary brachytherapy for cervical cancer: what the radiologist needs to know.
AJR Am J Roentgenol. 2011; 196(3):W341-7 [PubMed]
OBJECTIVE: Intracavitary brachytherapy has an important role in treating cervical cancer. MRI is the optimal imaging technique to visualize the intracavitary brachytherapy probes and MRI-guided intracavitary brachytherapy is expected to increase significantly over the next 5 years. The purpose of this article is to review what a radiologist needs to know about imaging brachytherapy probes including the MR technique, correct positioning of the probes, and associated complications.
CONCLUSION: MRI-guided intracavitary brachytherapy is an increasingly used therapy for the treatment of cervical cancer. This technique provides excellent visualization of intracavitary brachytherapy devices and allows accurate localization of residual tumor. It is important for radiologists to be familiar with the correct probe positioning as well as any potential complications.
Department of Radiology, University of Cambridge, Addenbrooke's Hospital


Van den Bossche J, Al-Jamal WT, Yilmazer A, et al.
Intracellular trafficking and gene expression of pH-sensitive, artificially enveloped adenoviruses in vitro and in vivo.
Biomaterials. 2011; 32(11):3085-93 [PubMed]
Recombinant adenovirus (Ad) has shown great promise in gene therapy. Artificial envelopment of adenovirus within lipid bilayers has previously been shown to decrease the immunogenicity and hepatic affinity of naked Ad in vivo. Unfortunately, this also resulted in a significant reduction of gene expression, which we attributed to poor endosomal release of the Ad from its artificial lipid envelope. In this work, we explored the artificial envelopment of Ad within pH-sensitive DOPE:CHEMS bilayers and characterized this vector by TEM, AFM, dot blot, dynamic light scattering and zeta potential measurements. The artificially enveloped viral vectors exhibited good stability at physiological pH but immediately collapsed and released naked Ad virions at pH 5.5. Intracellular trafficking using confocal laser scanning microscopy (CLSM) revealed that Cy3-labelled Ad enveloped in DOPE:CHEMS bilayers exhibited the characteristic Ad distribution within the cytoplasm that led to virion accumulation around the nuclear membrane, indicating endosomal release of Ad. We obtained equivalent levels of gene expression as those of naked Ad in a series of CAR-positive (CAR+) and CAR-negative (CAR-) cell lines. This suggested that the mechanism of infection for the artificially enveloped Ad remained dependent on the presence of CAR receptors. Finally, the pH-sensitive enveloped Ad were injected intratumorally in human cervical carcinoma xenograft-bearing nude mice, also illustrating their capacity for efficient in vivo marker gene expression. This study is a step forward toward the engineering of functional, artificially enveloped adenovirus vectors for gene transfer applications.
Nanomedicine Laboratory, Centre for Drug Delivery Research, The School of Pharmacy, University of London, 29-39 Brunswick Square, London WC1N 1AX


Powell ME
Modern radiotherapy and cervical cancer.
Int J Gynecol Cancer. 2010; 20(11 Suppl 2):S49-51 [PubMed]
For most cervical cancers, radiotherapy is the mainstay of treatment. The introduction of concurrent chemotherapy to radiation at the end of the 20th century led to a significant improvement in disease survival. Now, techniques such as intensity-modulated radiotherapy, which allow a high degree of conformity to the tumor, offer the opportunity to further improve outcome by reducing treatment-related toxicity and also to potentially improve local control by an increase in tumor dose. This review will outline the history and current state of play of cervical radiotherapy.
Department of Radiotherapy, St Bartholomew's Hospital, London


Vanni T, Legood R, Franco EL, et al.
Economic evaluation of strategies for managing women with equivocal cytological results in Brazil.
Int J Cancer. 2011; 129(3):671-9 [PubMed]
In Brazil, current management of women with screening results of atypical squamous cells of undetermined significance (ASC-US) is to offer repeat testing at 6-month intervals. Alternative management strategies that have been adopted in many high-income settings are to offer immediate colposcopy referral or to utilise human papillomavirus (HPV) DNA testing as a triage for colposcopy referral, and to consider different strategies according to women's age. The objective of our study was to evaluate the lifetime cost effectiveness in terms of cost per years of life saved (YLS) of these alternative strategies for a middle income setting. A Markov model was developed using data from the Ludwig-McGill cohort and calibrated to independent observational datasets and local cost estimates obtained. In the base-case analysis, repeat cytology was the least costly strategy but also the least effective. Based on the WHO threshold for very cost-effective interventions, HPV triage for women above 30 years-old was the strategy with the highest probability of being cost effective. HPV triage including younger women with ASCUS results would also be a cost-effective option. Whilst there was a slight further gain in effectiveness with immediate colposcopy referral, it was also more expensive and did not appear to be cost effective. Threshold analysis indicated that an HPV test would have to be more than twice as expensive as a cytology test for HPV triage to no longer be cost effective. In conclusion, our results indicate that in middle income settings HPV triage is likely to be the optimal strategy for managing women presenting with ASC-US results.
Department of Health Service Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London


Azam F, Shams-ul-Islam M
Prevention of human papilloma virus infection with vaccines.
J Pak Med Assoc. 2010; 60(8):676-81 [PubMed]
Human Papilloma virus (HPV) is present in all the cases of cervical cancer. It can also cause other diseases like genital warts, condylomata accuminata, cervical intraepithelial neoplasia and Anogenital cancers. Cervical cancer is the second most common cause of death from cancer. To improve the mortality from cervical cancers it is extremely important to prevent the HPV infection. In this review we have discussed the role of HPV vaccines in preventing the HPV infections and so the cervical cancer.
Medical Oncology, Churchill Hospital, Oxford


Kitchener HC, Hoskins W, Small W, et al.
The development of priority cervical cancer trials: a Gynecologic Cancer InterGroup report.
Int J Gynecol Cancer. 2010; 20(6):1092-100 [PubMed]
Since the late 1990s, when a spate of US studies reported the benefit of chemoradiation for cervical cancer, there has been a dearth of clinical trials in cervical cancer. This requires to be addressed with urgency because this disease is responsible for a quarter of a million deaths globally each year, mostly in developing countries, but therapeutic advances are required in all health care settings. The Gynecologic Cancer InterGroup (GCIG) is a worldwide collaborative of leading national groups that develops and promotes multinational trials in gynecologic cancer. In recognition of the pressing need for action, the GCIG convened an international meeting with expert representations from most of the GCIG groups and selected large centers in low- and middle-income countries. The focus was to identify consensus on several concepts for clinical trials, which would be developed and promoted by the GCIG and launched with major international participation. The first half of the meeting was devoted to a resume of the current state of the knowledge and identifying the gaps most needing new evidence. The second half of the meeting was concerned with achieving consensus on the way forward. There were 2 principal outcomes. The first was a proposal to establish, under the umbrella of GCIG, a cervical cancer trials network of centers from countries currently outside GCIG (Eastern Europe, India, Thailand, Southern Africa, and South and Central America), which could increase international participation in trials, conducted within the principles of good clinical practice. The second was to identify the priorities for clinical trials. These included additional systemic therapy before or after chemoradiation; less radical surgery for small, early-stage tumors; the use of fewer fractions to improve cost-effectiveness of treatment in centers with limited resources; and chemotherapy to improve resectability of bulky tumors.
University of Manchester Academic Health Science Centre, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester


Mannelli L, Patterson AJ, Zahra M, et al.
Evaluation of nonenhancing tumor fraction assessed by dynamic contrast-enhanced MRI subtraction as a predictor of decrease in tumor volume in response to chemoradiotherapy in advanced cervical cancer.
AJR Am J Roentgenol. 2010; 195(2):524-7 [PubMed]
OBJECTIVE: In this study, we evaluated the feasibility of using dynamic contrast-enhanced MRI (DCE-MRI) subtracted images as a predictor of a decrease in tumor volume in response to chemoradiotherapy in 13 patients with cervical cancer.
CONCLUSION: This study shows that pretreatment tumor nonenhancing fraction assessed with arterial image subtraction inversely predicts the chemoradiation response in cervical cancer.
Department of Radiology and Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital


Walter T
Jade and the journalists: media coverage of a young British celebrity dying of cancer.
Soc Sci Med. 2010; 71(5):853-60 [PubMed]
In contemporary western societies, dying usually occurs in old age, out of sight in hospitals and institutions; how then do lay people learn what dying is like? Since the 1970s, one source of information in Anglophone societies has come from individuals who have chosen to publicise their dying of cancer. This article examines the most high profile case of this to date in the UK; in 2009, celebrity Jade Goody publicised in tabloid newspapers and celebrity magazines the final weeks of her dying of cervical cancer. What did she and her media say and write about dying? This article examines the print coverage of her final weeks, and four different voices are identified: those of Goody, of journalists, of her publicist, and of photographers, each representing her dying somewhat differently. Two major themes are discussed: Jade's struggles to retain autonomy (challenged by her disease and by other people), and the framing of her final weeks not primarily as a typical media cancer story of heroism, but as one of redemption in which she attained social respectability through dying.
Centre for Death & Society, SPS, University of Bath, Claverton Down, Bath BA2 7AY


Cuzick J, Ambroisine L, Cadman L, et al.
Performance of the Abbott RealTime high-risk HPV test in women with abnormal cervical cytology smears.
J Med Virol. 2010; 82(7):1186-91 [PubMed]
HPV DNA testing is known to be much more sensitive than cytology, but less specific. A range of HPV and related tests in 858 women referred for colposcopy because of an abnormal smear were evaluated to compare the performances of these tests. This article compared the Abbott test to other tests which had been previously evaluated. This test was a real true test for 14 high-risk HPV types. The Abbott test was found to be highly sensitive for cervical intraepithelial neoplasia grade 3 or worse (CIN3+) (98.9%) with a specificity of 31.5%. These numbers were comparable with the Qiagen HC2 test, the Roche Linear Array and Amplicor tests, and the Gen-Probe APTIMA test. Differences between these tests appeared to be related mostly to the choice of cutoff level. An added feature of the Abbott test was the provision of type specific results for HPV 16 and 18.
Wolfson Institute of Preventive Medicine, Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Queen Mary University of London, London


Gray E, Pett MR, Ward D, et al.
In vitro progression of human papillomavirus 16 episome-associated cervical neoplasia displays fundamental similarities to integrant-associated carcinogenesis.
Cancer Res. 2010; 70(10):4081-91 [PubMed] Free Access to Full Article
An important event in the development of cervical squamous cell carcinoma (SCC) is deregulated expression of high-risk human papillomavirus (HR-HPV) oncogenes, most commonly related to viral integration into host DNA. Mechanisms of development of the approximately 15% of SCCs that contain extrachromosomal (episomal) HR-HPV are poorly understood due to limited longitudinal data. We therefore used the W12 model to study mechanisms of cervical carcinogenesis associated with episomal HPV16. In vitro progression of W12 normally occurs through selection of cells containing integrated HPV16. However, in one long-term culture, keratinocytes developed a selective growth advantage and invasive phenotype while retaining HPV16 episomes at increased copy number in the absence of transcriptionally active integrants. Longitudinal investigations revealed similarities between the episome- and integrant-associated routes of neoplastic progression. Most notable were dynamic changes in viral early gene expression in episome-retaining cells, consistent with continually changing selective pressures. An early increase in viral transcription preceded elevated episome copy number and was followed by a reduction to near baseline after the development of invasiveness. Episomal transcriptional deregulation did not require selection of a specific sequence variant of the HPV16 upstream regulatory region, although increased levels of acetylated histone H4 around the late promoter implicated a role for altered chromatin structure. Interestingly, invasive episome-retaining cells showed high levels of HPV16 E2/E6 proteins (despite decreased transcript levels) and reduced expression of IFN-stimulated genes, adaptations that support viral persistence and cell survival. Our findings suggest a unified working model for events important in cervical neoplastic progression regardless of HR-HPV physical state.
Medical Research Council Cancer Cell Unit, University of Cambridge, Cambridge
Research funded by:


Sanu O, Pal A, George S
A pilot study comparing efficacy of a cervical intraepithelial neoplasia Excisor with loop electrosurgical excision procedure.
Eur J Obstet Gynecol Reprod Biol. 2010; 151(1):91-5 [PubMed]
OBJECTIVE: To determine whether the proportion of incomplete resection of cervical intraepithelial neoplasia (CIN 1-3) may be reduced by CIN Excisor compared with loop excision of the transformation zone (LLETZ).
STUDY DESIGN: A prospective trial during a 2-year period at a district general hospital in London, United Kingdom, including 420 women scheduled for treatment due to CIN, after colposcopy guided biopsy results. This study was expected to demonstrate a statistically significant difference (p<0.05) in the proportion of women with clear histopathological resection margins after treatment with CIN Excisor compared with LLETZ. Chi-square or Fisher's exact test were used to compare histopathological resection margins in the CIN Excisor and LLETZ groups.
RESULTS: Overall, there is strong evidence of a difference in the proportion of histopathological specimens with clear resection margins for the CIN Excisor group, compared with the LLETZ group (201/210, 95.7% versus 180/210, 85.7%: p<0.001). Sub-analysis within the two groups, of the proportion of histopathological specimens with clear resection margins in relation to CIN grades, revealed a statistically significant difference in favour of the CIN Excisor group for CIN 1 (99/103, 96.1% versus 82/95, 86.3%: p=0.01), and CIN 2 (73/77, 94.8% versus 68/80, 85%: p=0.04). There is a numerical difference in the proportion of clear resection margins in favour of the CIN Excisor for CIN 3 (29/30, 96.7% versus 30/35, 85.7%), but this difference was not statistically significant (p=0.21). Perioperative complications were similar between the two groups.
CONCLUSION: CIN Excisor achieved better results than LLETZ for treatment of CIN 1-3 with respect to clear histopathological resection margins. However, further studies including a larger number of women treated for CIN 3 are needed before firm conclusions are drawn.
Department of Obstetrics and Gynaecology, St Marys Imperial College NHS Trust, London W2


Constandinou-Williams C, Collins SI, Roberts S, et al.
Is human papillomavirus viral load a clinically useful predictive marker? A longitudinal study.
Cancer Epidemiol Biomarkers Prev. 2010; 19(3):832-7 [PubMed] Free Access to Full Article
BACKGROUND: It has been suggested that in women who test positive for high-risk human papillomavirus (HPV) types, viral load can distinguish women who are at increased risk of cervical neoplasia from those who are not.
METHODS: Quantitative PCR (qPCR) was used to measure HPV copy number in serial samples taken from 60 and 58 young women previously found to have incident cervical HPV16 or HPV18 infections, respectively, using GP5+/GP6+ primers; women provided at least three samples for qPCR testing, at least one of which was positive.
RESULTS: A 10-fold increase in HPV16 or HPV18 copy number was associated with a modestly increased risk of acquiring a cytologic abnormality [HPV16: hazards ratio, 1.76 (95% confidence interval, 1.38-2.25); HPV18: hazards ratio, 1.59 (95% confidence interval, 1.25-2.03)]. However, in most women, copy number increased during follow-up, before decreasing again. In women with a HPV16 infection, the median copy number per 1,000 cells was 7.7 in their first qPCR HPV-positive sample, 1,237 in the sample yielding the maximum copy number, and 7.8 in their last qPCR HPV-positive sample; corresponding copy numbers for women with HPV18 infection were 2.3, 87, and 2.4. Maximum HPV16 and HPV18 copy number did not differ significantly between women who acquired an incident cervical cytologic abnormality and those who did not.
CONCLUSION: Whereas large relative increases in copy number are associated with an increased risk of abnormality, a single measurement of viral load made at an indeterminate point during the natural history of HPV infection does not reliably predict the risk of acquiring cervical neoplasia. Therefore, a single measure of HPV viral load cannot be considered a clinically useful biomarker.
Cancer Research UK Institute for Cancer Studies, University of Birmingham, Edgbaston, Birmingham
Research funded by:


Donaldson SB, West CM, Davidson SE, et al.
A comparison of tracer kinetic models for T1-weighted dynamic contrast-enhanced MRI: application in carcinoma of the cervix.
Magn Reson Med. 2010; 63(3):691-700 [PubMed]
The Tofts tracer kinetic models are often used to analyze dynamic contrast-enhanced MRI data. They are derived from a general two-compartment exchange model (2CXM) but assume negligible plasma mean transit time. The 2CXM estimates tissue plasma perfusion and capillary permeability-surface area; the Tofts models estimate the transfer constant K(trans), which reflects a combination of these two parameters. The aims of this study were to compare the 2CXM and Tofts models and report microvascular parameters in patients with cervical cancer. Thirty patients were scanned pretreatment using a dynamic contrast-enhanced MRI protocol with a 3 sec temporal resolution and a total scan duration of 4 min. Whole-tumor parameters were estimated with both models. The 2CXM provided superior fits to the data for all patients (all 30 P values < 0.005), and significantly different parameter estimates were obtained (P < 0.01). K(trans) (mean = 0.35 +/- 0.26 min(-1)) did not equal absolute values of tissue plasma perfusion (mean = 0.65 +/- 0.56 mL/mL/min) or permeability-surface area (mean = 0.14 +/- 0.09 mL/mL/min) but correlated strongly with tissue plasma perfusion (r = 0.944; P = 0.01). Average plasma mean transit time, calculated with the 2CXM, was 22 +/- 16 sec, suggesting the assumption of negligible plasma mean transit time is not appropriate in this dataset and the 2CXM is better suited for its analysis than the Tofts models. The results demonstrate the importance of selecting an appropriate tracer kinetic model in dynamic contrast-enhanced MRI.
Imaging Science and Biomedical Engineering, University of Manchester, Manchester
Research funded by:


See publications from around the world in CancerIndex: Cervical Cancer

This page last updated: 22nd May 2013
Displaying links verified within last 2 weeks at time of update.

Cancer UK Website

Home
Cancer Types
Locations
Government & NHS
Organisations
Support
Research
About

Disclaimer

© 1996-2013