Epidemiology of Cervical Cancer

  • Anjum MemonEmail author
  • Peter Bannister


Worldwide, cervical cancer is the fourth most common cancer among women, with an estimated 528,000 new cases (7.9% of cancer in women) and 266,000 deaths (7.5% of cancer deaths in women) in the year 2012 and a 5-year prevalence of 1.5 million cases (9% of women with cancer). About 85% of the cases occur in developing countries, where cervical cancer accounts for 12% of all cancers in women. The cervical and endometrial cancers originate in the uterus but differ drastically in terms of aetiology, clinical presentation and characteristics, prognosis and survival. Cervical cancer is a model of viral carcinogenesis and most common in developing countries, whereas endometrial cancer is a model of hormonal carcinogenesis and most common in developed countries. The aim of this chapter is to provide an overview of key concepts in cancer epidemiology and to describe the global patterns and trends in incidence and mortality, aetiology and prevention of cervical cancer.


Epidemiological concepts in cervical cancer Gynaecological cancers Cervical cancer epidemiology Incidence of cervical uterine cancer Mortality in cervical cancer Prevention of cervical uterine cancer 


  1. 1.
    Memon A. Epidemiological understanding: an overview of basic concepts and study designs. In: Pencheon D, et al., editors. Oxford handbook of public health practice. 2nd ed. Oxford: Oxford University Press; 2006. p. 100–11.Google Scholar
  2. 2.
    Memon A. Epidemiology of gynaecological cancers. In: Shafi M, et al., editors. Gynaecological oncology. Cambridge: Cambridge University Press; 2010. p. 1–13.Google Scholar
  3. 3.
    Forman D, Bray F, Vrewster D, et al. Cancer incidence in five continents, Vol X (electronic version) Lyon, IARC. 2013. Available from:
  4. 4.
    Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from:
  5. 5.
    The Surveillance, Epidemiology, and End Results (SEER) Program. Available from:
  6. 6.
    National Cancer Institute. Cervical cancer. 2014. Available from:
  7. 7.
    Centers for Disease Control and Prevention (CDC), National Programme of Cancer Registries (NPCR). Available from: and
  8. 8.
    Ryerson A, Eheman C, Altekruse S, et al. Annual report to the nation on the status of cancer, 1975–2012, featuring the increasing incidence of liver cancer. Cancer. 2016;122(9):1312–37.CrossRefGoogle Scholar
  9. 9.
    Ylitalo N, Stuver S, Adami H. Cervical cancer. In: Hans-Olov A, et al., editors. Textbook of cancer epidemiology. 2nd ed. New York: Oxford University Press; 2008. p. 446–67.CrossRefGoogle Scholar
  10. 10.
    Cancer Research UK. Available from:
  11. 11.
    Schiffman M, Castle P, Jeronimo J, et al. Human papillomavirus and cervical cancer. Lancet. 2007;370(9590):890–907.CrossRefGoogle Scholar
  12. 12.
    Castle P, Rodriguez A, Burk R, et al. Short term persistence of human papillomavirus and risk of cervical precancer and cancer: population based cohort study. BMJ. 2009;339:b2569.CrossRefGoogle Scholar
  13. 13.
    Crosbie E, Einstein M, Franceschi S, et al. Human papillomavirus and cervical cancer. Lancet. 2013;382(9895):889–99.CrossRefGoogle Scholar
  14. 14.
    Guan P, Howell-Jones R, Li N, et al. Human papillomavirus types in 115,789 HPV-positive women: a meta-analysis from cervical infection to cancer. Int J Cancer. 2012;131(10):2349–59.CrossRefGoogle Scholar
  15. 15.
    Li N, Franceschi S, Howell-Jones R, et al. Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: variation by geographical region, histological type and year of publication. Int J Cancer. 2011;128(4):927–35.CrossRefGoogle Scholar
  16. 16.
    Cox J. The development of cervical cancer and its precursors: what is the role of human papillomavirus infection? Curr Opin Obstet Gynecol. 2006;18(suppl.1):S5–S13.CrossRefGoogle Scholar
  17. 17.
    Sellors J, Karwalajtys T, Kaczorowski J, et al. Incidence, clearance and predictors of human papillomavirus infection in women. CMAJ. 2003;168(4):421–5.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Dunne E, Unger E, Stenberg M, et al. Prevalence of HPV infection among females in the United States. JAMA. 2007;297(8):813–9.CrossRefGoogle Scholar
  19. 19.
    Plummer M, de Martel C, Vignat J, et al. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Health. 2016;4(9):609–16.CrossRefGoogle Scholar
  20. 20.
    Franceschi S, Herrero R, Clifford G, et al. Variations in the age-specific curves of human papillomavirus prevalence in women worldwide. Int J Cancer. 2006;119(11):2677–84.CrossRefGoogle Scholar
  21. 21.
    De Sanjose S, Diaz M, Castellsague X, et al. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis. 2007;7(7):453–9.CrossRefGoogle Scholar
  22. 22.
    International Collaboration of Epidemiological Studies of Cervical Cancer. Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer. 2006; 118 6 :1481–95.Google Scholar
  23. 23.
    Kapeu A, Luostarinen T, Jellum E, et al. Is smoking an independent risk factor for invasive cervical cancer? A nested case-control study within Nordic biobanks. Am J Epidemiol. 2008;169(4):480–8.CrossRefGoogle Scholar
  24. 24.
    Plummer M, Herrero R, Franceschi S, et al. Smoking and cervical cancer: pooled analysis of the IARC multi-centric case-control study. Cancer Causes Control. 2003;14(9):805–14.CrossRefGoogle Scholar
  25. 25.
    Schiffman M, Brinton L. The epidemiology of cervical carcinogenesis. Cancer. 1995;76(suppl.10):1888–901.CrossRefGoogle Scholar
  26. 26.
    Palefsky J, Holly E. Molecular virology and epidemiology of human papillomavirus and cervical cancer. Cancer Epidemiol Biomark Prev. 1995;4(4):415–28.Google Scholar
  27. 27.
    Burger M, Hollema H, Gouw A, et al. Cigarette smoking and human papillomavirus in patients with reported cervical cytological abnormality. BMJ. 1993;306(6880):749–52.CrossRefGoogle Scholar
  28. 28.
    International Agency for Research on Cancer. Human papillomavirus. IARC monographs. 2012; 100b:255–313.Google Scholar
  29. 29.
    De Vuyst H, Gichangi P, Estambale B, et al. Human papillomavirus types in women with invasive cervical carcinoma by HIV status in Kenya. Int J Cancer. 2008;122(1):244–6.CrossRefGoogle Scholar
  30. 30.
    Sun X, Kuhn L, Ellerbrock T, et al. Human papillomavirus infection in women infected with the human immunodeficiency virus. N Engl J Med. 1997;337(19):1343–9.CrossRefGoogle Scholar
  31. 31.
    Rohner E, Sengayi M, Goeieman B, et al. Cervical cancer risk and impact of pap-based screening in HIV-positive women on antiretroviral therapy in Johannesburg, South Africa. Int J Cancer. 2017;141(3):488–96.CrossRefGoogle Scholar
  32. 32.
    Strickler H, Palefsky J, Shah K, et al. Human papillomavirus type 16 and immune status in human immunodeficiency virus-seropositive women. J Natl Cancer Inst. 2003;95(14):1062–71.CrossRefGoogle Scholar
  33. 33.
    Dahlstrom L, Andersson K, Luostarinen T, et al. Prospective seroepidemiologic study of human papillomavirus and other risk factors in cervical cancer. Cancer Epidemiol Biomark Prev. 2011;20(12):2541–50.CrossRefGoogle Scholar
  34. 34.
    Smith J, Bosetti C, Munoz N, et al. Chlamydia trachomatis and invasive cervical cancer: a pooled analysis of the IARC multicentric case-control study. Int J Cancer. 2004;111(3):431–9.CrossRefGoogle Scholar
  35. 35.
    Smith J, Munoz N, Herrero R, et al. Evidence for chlamydia trachomatis as a human papillomavirus cofactor in the etiology of invasive cervical cancer in Brazil and the Philippines. J Infect Dis. 2002;185m(3):324–31.CrossRefGoogle Scholar
  36. 36.
    Wallin K, Wiklund F, Luostarinen T, et al. A population-based prospective study of chlamydia trachomatis infection and cervical carcinoma. Int J Cancer. 2002;101(4):371–4.CrossRefGoogle Scholar
  37. 37.
    Koskela P, Anttila T, Bjorge T, et al. Chlamydia trachomatis infection as a risk factor for invasive cervical cancer. Int J Cancer. 2000;85(1):35–9.CrossRefGoogle Scholar
  38. 38.
    Munoz N, Franceschi S, Bosetti C, et al. Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet. 2002;359(9312):1093–101.CrossRefGoogle Scholar
  39. 39.
    Silins I, Ryd W, Strand A, et al. Chlamydia trachomatis infection and persistence of human papillomavirus. Int J Cancer. 2005;116(1):110–5.CrossRefGoogle Scholar
  40. 40.
    Winer R, Hughes J, Feng Q, et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006;354(25):2645–54.CrossRefGoogle Scholar
  41. 41.
    Ursin G, Pike M, Preston-Martin S, et al. Sexual, reproductive and other risk factors for adenocarcinoma of the cervix: results from a population-based case-control study (California, United States). Cancer Causes Control. 1996;7(3):391–401.CrossRefGoogle Scholar
  42. 42.
    Lee J, So K, Piyathilake C, et al. Mild obesity, physical activity, calorie intake, and the risks of cervical intraepithelial neoplasia and cervical cancer. PLoS One. 2013;8(6):e66555.CrossRefGoogle Scholar
  43. 43.
    Garcia-Closas R, Castellsague X, Bosch X, et al. The role of diet and nutrition in cervical carcinogenesis: a review of recent evidence. Int J Cancer. 2005;117(4):629–37.CrossRefGoogle Scholar
  44. 44.
    Peirson L, Fitzpatrick-Lewis D, Ciliska D, et al. Screening for cervical cancer: a systematic review and meta-analysis. Syst Rev. 2013;2:35.CrossRefGoogle Scholar
  45. 45.
    NHS Choices. Available from:
  46. 46.
    Landy R, Pesola F, Castanon A, et al. Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case-control study. Br J Cancer. 2016;115(9):1140–6.CrossRefGoogle Scholar
  47. 47.
    Leeman A, del Pino M, Molijn A, et al. HPV testing in first-void urine provides sensitivity for CIN2+detection comparable with a smear taken by a clinician or a brush-based self-sample: cross-sectional data from a triage population. BJOG. 2017;124(9):1356–63.CrossRefGoogle Scholar
  48. 48.
    Blake D, Crosbie E, Kitson S. Urinary HPV testing may offer hope for cervical screening non-attenders. BJOG. 2017;124(9):1364.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Primary Care and Public HealthBrighton and Sussex Medical SchoolBrightonUK

Personalised recommendations