The cervix is the lower portion of the uterus that connects to the vagina. There are two main types of cervical cancer, squamous cell carcinoma and adenocarcinoma, in addition to neoplasia, the abnormal growth of cells that may progress to cervical cancer. Infection with the human papilloma virus (HPV) is considered to be the main cause of cervical cancer.1 Other risk factors for cervical cancer include having sex at a younger age, multiple sexual partners or a high-risk sexual partner, immunosuppression, history of a sexually-transmitted infection or HPV-related vulvar or vaginal neoplasia, and smoking.2
In 2024, 1,030 women were diagnosed with cervical cancer and 243 deaths were recorded.3,4 The inclusion of the HPV vaccine under the National Immunisation Program, and the introduction of the National Cervical Screening Program has led to a decrease in the incidence and mortality of cervical cancer in Australia.5 The chance of a person surviving for at least five years after diagnosis is 76%, based on data from 2016–2020.6
Cervical cancer is often treated with a hysterectomy. This has considerable negative effects for the patient, as can mean early menopause and the inability to become pregnant. Side effects from treatments such as chemotherapy and radiotherapy also make living with cervical cancer difficult.7
3.5.5.1 Risk associated with smoking
People who smoke are more likely to develop cervical cancer. The IARC and US Surgeon General reports in 2004 both concluded that smoking is a cause of cervical cancer.8,9 Subsequent meta-analyses have supported this conclusion.10,11 A 2022 meta-analysis estimated that women who currently smoke have a 70% higher risk of cervical cancer compared to women who have never smoked. This meta-analysis also found that women who smoke have a 111% greater risk of cervical neoplasia, compared to women who have never smoked.10 A 2019 meta-analysis of two cohort and three case–control studies among Japanese women also found that smoking increases the risk of cervical cancer.11 A number of studies support a doubling of risk for people who smoke.10-13 Additional meta-analyses have found that exposure to secondhand smoke is associated with an increased risk of cervical cancer.14-16 See Section 4.10.3 for further information on secondhand smoke and cervical cancer.
3.5.5.2 How tobacco smoke causes cervical cancer
Polyaromatic hydrocarbons (PAH) and NNK are tobacco carcinogens considered likely to be involved in causing cervical cancer.9 Cervical samples from people who smoke have higher levels of DNA adducts (DNA bonded to a carcinogenic chemical) compared to people who do not smoke.8 It is predicted that in combination with HPV these compounds may contribute to the development of cervical cancer among people who smoke.8,17
Tobacco-related carcinogens are also suspected to increase the duration of infection of HPV, the main cause of cervical cancer.12,18
3.5.5.3 Factors affecting risk
HPV infection
Infection with specific strains of high-risk HPV is considered to be the main cause of cervical cancer and may be causing most, if not all cervical cancers. Most (>95%) of cervical tumours contain DNA evidence of HPV infection and the biological mechanisms by which HPV leads to cancer formation are well-established.19,20 HPV infection is quite common, with approximately one quarter of Australian adult women having evidence of infection at some stage of their lives with HPV strains that are capable of causing cervical cancer.21 Worldwide, 6.2% of asymptomatic women have high-risk HPV DNA detectable in cervical samples,22 indicating prevalent infection. Since only a small proportion of people with evidence of infection with high-risk HPV go on to develop cervical cancer, this implies that other risk factors contribute to the development of cervical cancer.
Smoking has been shown to double the risk of cervical cancer for people with HPV infection.23
In a large study of over 300,000 women, a history of smoking was found to be associated with cervical cancer in the those without evidence of HPV exposure.24 However, this study used antibodies for detection of cervical cancer exposure, which may have led to false negative results for HPV exposure. When a more sensitive HPV DNA test is used, a very high proportion of cervical cancer cases are associated with HPV infection.19 To date, there is insufficient evidence to conclude that smoking is associated with cervical cancer in people without a history of high-risk HPV infection.
Cancer type
The risk from smoking differs for different types of cervical cancer. There is evidence that smoking increases the risk of squamous cell carcinoma, the most common type of cervical cancer, but not adenocarcinoma.12,25
Intensity and duration of smoking
There is a dose–response relationship between smoking and cervical cancer; the risk of cervical cancer increases with the duration of smoking.9,11
Smoking cessation
Smoking cessation reduces the risk of cervical cancer.26 A 2003 meta-analysis of 28 studies compared the risk of cervical cancer among people who currently and formerly smoked to those who had never smoked. The relative risk of cervical cancer for people who formerly smoked was lower than that for people who currently smoked (1.26 fold compared to 1.83 fold).27 A 2022 meta-analysis found that the risk of cervical cancer decreases with years since quitting. The risk of cervical cancer for people who formerly smoked reached the same level as that for people who never smoked, after 16.5 years since quitting.10
3.5.5.4 Impact of smoking on prognosis
Several studies suggest that smoking affects the prognosis for women with cervical cancer. A study in the US involving approximately 2,500 women with cervical cancer, who were followed-up for five years, found that those who smoked were about 20% more likely to die from cervical cancer.28 Former and current smoking were also associated with decreased survival and reduced disease control for cervical cancer patients undergoing radiotherapy.29
Related reading
Test your knowledge
References
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4. Australian Institute of Health and Welfare. Cancer data in Australia. Data tables: CDIA 2024: Book 2a – Cancer mortality (age-standardised rates and 5-year age groups) Canberra: AIHW. 2024. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/data.
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