Updated: Nov 15
Cervical cancer is cancer that develops on the cervix, or the lower end of the uterus near the vaginal canal. HPV is believed to cause most cervical cancers. Cervical cancer typically develops as a result of human papillomavirus (HPV) that is usually transmitted via sexual contact. It is possible for a person to develop cervical cancer if they have never had sex, but it’s highly unlikely for someone to develop cervical cancer if they have never had sex, unless they have had some sexual activity that could present the HPV to the vagina, which leads to the cervix.
The evidence shows that if a person has not had sex, their risk of developing cervical cancer is very low, although the risk is ‘low risk’ not ‘no risk’. Human Papillomavirus (HPV), which causes at least 99.7% of cervical cancers, can be passed on by any sort of sexual contact. It is important to remember that penetrative sexual intercourse is not the only way a person can contract HPV. And it’s important to understand that people can transmit HPV via vaginal, anal, oral sex, genital touching, shared use of sex toys, and the transference of vaginal fluids on the hands and fingers. HPV is spread through skin-on-skin contact, any genital-on-genital stimulation can result in the exchange of HPV. That means people can transmit the virus through penis-on-penis, vulva-on-vulva, and penis-on-vulva contact.
Causes unrelated to HPV
Although HPV is the most common cause of cervical cancer, it is not the only cause. Other factors that increase a person’s chance of developing cervical cancer include:
Smoking: Those who smoke are twice as likely to develop cervical cancer compared with those who do not. Researchers believe that there are substances in tobacco products that damage the DNA of the cells in the cervix.
Long-term use of oral contraceptives: Taking oral contraceptives for a long time can increase the risk of developing cervical cancer. However, the risk goes back down after a person stops taking them.
Family history: It may be that cervical cancer runs in families. In some cases, this may be because people in the same family are more likely to have similar non-genetic risk factors.
People who have had a chlamydia infection also may have a higher risk of cervical cancer.
A weakened immune system: The immune system helps to destroy cancer cells, slow their growth, and reduce their spread. Those with HIV or those undergoing treatment for autoimmune conditions have a weakened immune system.
Cervical cancer risk factor
HPV is most commonly transmitted during sexual intercourse and sexual activities. Therefore, people who have or have had sex are at risk for developing cervical cancer. Here are some of the cervical cancer risk factors:
Other sexually transmitted infections (STIs). Having other STIs — such as chlamydia, gonorrhea, syphilis and HIV/AIDS — increases your risk of HPV. People who have had a chlamydia infection also may have a higher risk of cervical cancer. That’s because this STI may encourage the growth of HPV, and that may lead to a quicker development of cervical cancer.
Many sexual partners. The greater your number of sexual partners — and the greater your partner's number of sexual partners — the greater your chance of acquiring HPV.
Early sexual activity. Having sex at an early age increases your risk of HPV.
Smoking. Smoking is associated with squamous cell cervical cancer. women who smoke are twice as likely as non-smokers to develop cervical cancer. Research suggests byproducts of the tobacco product can damage the DNA of cervical cells. Research has also shown that among women with HPV infections, those who smoke have a much higher HPV viral load on the cervix. This increases the risk of cervical cancer.
Exposure to miscarriage prevention drugs. If your mother took a drug called diethylstilbestrol (DES) while pregnant in the 1950s, you may have an increased risk of a certain type of cervical cancer called clear cell adenocarcinoma.
A weakened immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV. Causes of a weakened immune system: HIV, cancer, chemotherapy, autoimmune conditions, and organ transplants.
Women who are overweight or obese are at twice the risk of cervical adenocarcinoma than women of normal weight.
Use of vaginal cleansers (douching). A healthy vagina must contain lactobacillus bacteria, which are good bacteria to maintain the acidity of the vagina so that germs don't easily infect. The habit of using vaginal fluids (douching) will eradicate these bacteria so that the vagina is more susceptible to infection.
Economic status. Females living in low-income households often do not have equal access to healthcare services like cervical cancer screenings.
How common is cervical cancer?
Cervical cancer is the fourth most common cancer among women worldwide, with an estimated incidence of 570.000 cases and 311.000 deaths, reported in 2018. It is estimated that around 85% of deaths worldwide from cervical cancer occur in low and middle income countries, where the death rate is 18 times higher than in developed countries. It is known that the cause of cervical cancer is the oncogenic subtype of the HPV (Human Papillomavirus) virus, especially subtypes 16 and 18. According to the IARC Globocan 2018 report, cervical cancer in Indonesia in 2018 ranks second to cancer in women after breast cancer with an incidence of 348.809 cases with a mortality rate of nearly 60% of the incidence of 207.210 deaths. The incidence of cervical cancer in Indonesia is estimated to have 180.000 new cases per year and the death rate is thought to reach 75% in the first year. This death is mainly associated with the majority of newly diagnosed patients who are already at an advanced stage (70% of cases) and even at the terminal stage at the time of diagnosis.
Cervical cancer can happen in females of any age. However, there are some trends.
Cervical cancer is most commonly diagnosed in females between ages 35 and 44 years.
The average age at the time of diagnosis is 50 years old.
Cervical cancer is rare in females who are under 20 years old.
Over 20 percent of cervical cancer diagnoses are in females who are over 65 years old.
So, if you don’t have sex, are you still at risk of cervical cancer?
Yes, even if you don’t have sex, you could still be at risk of cervical cancer.
HPV cells can live in more areas of the body than the genitals. They are sometimes present in the anus, mouth, and throat. Skin-to-skin contact, such as during oral sex, can transmit the virus. Penetrative sex is not the only way to transmit it. If you are not having sex now but have had sex in the past, you are still at risk for developing cervical cancer from HPV. HPV does not always cause obvious symptoms like warts. It can persist in the body for years and then develop into abnormal cells on the cervix later. These abnormal cells can become cancerous. Lastly, people who have never had any type of sexual intercourse or contact, including vaginal, oral, or anal sex, are unlikely to have HPV. However, it is possible to transmit HPV through non penetrative sexual contact.
Plus, HPV isn’t the only cause of cervical cancer. HPV causes nearly all cervical cancers. But nearly all ≠ all. When a person develops cervical cancer, they develop it because there is a disruption in the healthy cells in the cervix. These cells, for one reason or another, endure a mutation in their DNA (basically, the body’s instruction manual), that tells the cells to multiply over and over. An accumulation of atypical cells in the cervix often results in a tumor. Here’s where it gets complicated: While certain strains of HPV link to an increased risk of cervical cancer, not everyone who tests positive for those strains of HPV will go on to develop cervical cancer. This suggests that there are additional factors that determine your likelihood of developing cervical cancer.
You may be more likely to develop cervical cancer if you:
do not receive or complete the HPV vaccination series
have a family history of cervical cancer, or have a weakened immune system
take immunosuppressant medications, or take oral contraceptives over an extended period of time
smoke cigarettes, vape nicotine, or use other tobacco products
This article is written by: dr. Natalia Liau, MBBS, Msc.