Risk Factors for Cervical Cancer

This article discusses the risk factors associated with cervical cancer, focusing on the prevalence in Tanzania and sub-Saharan Africa. It explores the relationship between risk factors and the development of cervical cancer.

Running Head: RISK FACTORS FOR CERVICAL CANCER
Risk factors for Cervical Cancer
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Risk factors for Cervical Cancer
Introduction
According to the statistics of World Health Organization in 2002, cervical cancer has
been reported to be the world’s second dangerous form of cancer with an approximate of
493,250 women diagnosed having cancer and 2735000 losing their lives from cervical cancer
yearly. Moreover, cervical cancer has been reported to be the second most frequent among
women between 16-44 years of age. However, according to the 2010 health statistics, cervical
cancer is reported to be the fourth frequent cause of cancer mortalities amongst women
globally (Le & Holt, 2018). Annually, about 510000 new cases of cervical cancer (8% of all the
cancers linked to females) are diagnosed. In 2008, cervical cancer accounted for about 276000
people (7%) of the entire cancer mortalities amongst females. About 86% of the cases and
mortalities happened in developing nations (Teame et al. 2019). it should be noted that with
the coming up of screening programs in the developed nations, dysplastic lesion detection and
early testing of cervical cancer has become more common; therefore, the incidences and
occurrence of cervical cancer has reduced. However, there are various risk factors to cervical
cancer especially in Sub-Saharan Africa. This paper will critically discus the prevalence of
cervical cancer in Tanzania and the various risk factors of cervical cancer particularly in sub-
Saharan Africa. The paper will discuss the relationship between the identified risk factors of the
non-communicable disease (cervical cancer) using the understanding of the causation concept.

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Overview of Cervical Cancer
Cervical cancer is normally instigated by human papilloma virus, which is a major
frequent viral infection in human reproductive system. It should be noted that most of the
sexually active people will get contracted with human papilloma virus at certain point in their
lives and some people can get continuously infected (Zorogastua et al. 2017). The viral infection
peak period is immediately after getting sexually active while most people having health
immune systems can overcome the virus within some years after the infection. Long-term
infection having high risk of oncogenic forms of human papilloma virus put women at risk of
suffering cervical cancer (PR Newswire, 2018). To minimize effects of cervical cancer risks,
secondary and primary prevention approaches have been executed in the international north,
drastically minimizing level of cervical cancer mortalities as well as diagnosis. in international
south, cervical cancer has been reported to be most 2nd most cancer among females of
reproductive age. Globally, cervical cancer is the 3rd frequent carcinoma after colorectal cancer
and breast cancer. It should be noted that cervical cancer is fully preventable unlike other types
of cancer by making sure that women get quality and safety treatment and screening of
precancerous lesions. Effects of efforts of secondary intervention for cervical cancer prevention
strategies in settings with high resources is impressive. In spite of this, the estimates of the
World Health Organization concerning cervical cancer rates is still high, with over 500000 new
cases diagnosed yearly. 85% of women are from the developing nations in which access to
secondary as well as primary prevention is below the universally accepted level (Miri et al.
2018). In such environments, most women who are diagnosed with cervical cancer in
developing nations show at late stages when treatments are usually not easy to undertake.

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Globally, East Africa is a region having the maximum rate of cervical cancer. The age-
standardized occurrence rate in this region is approximated at around 43 new cases per 100000
females. Age-standardized incidence rates ranges between 76 new case per 100000 women in
Malawi to 40 new cases per 100000 women in Kenya (Mwaka et al. 2016). Tanzania is ranked
second in the region having an age-standardized occurrence rate of 55 new cases per 100000
women. It is interesting to note that similar to rate of cervical cancer in East Africa, cervical
cancer is principal cause of cancer-linked and cancer mortality among the Tanzanian women.
Annually, over 74000 females in Tanzania are found with cervical cancer while over half of
females living with cervical cancer lose their lives as they are diagnosed and treated at a late
stage of the illness (Mwaka et al. 2016). The difference in rates of the disease by region reflects
access to vital cervical cancer prevention strategies (Maree, Wright & Makua, 2011). However,
owing to the huge burden of the disease in Africa, the effect of HIV is not usually overlooked or
gainsaid. It has been empirically proven that females who are living with HIV are at high risk of
being infected with human papilloma virus as well as cervical dysplasia. Therefore, women
having HIV in Africa can have access to appropriate treatment strategies for HIV yet have little
or not access to life-saving treatment as well as screening for precancer of the cervix.
Appropriate treatment and screening for precancer of the cervix are a basic intervention
approach which has been executed worldwide to limit the prevalence of cervical cancer. The
most common utilized screening tests entail human papilloma virus testing, cytology, as well as
inspection through observation using acetic acid. Numerous researches have evaluated as well
as reevaluated the benefits and risks of every screening model.

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In the same case to the women population in other developing nations, most women in
Tanzania having cervical cancer are normally diagnosed and tested at late stages of the disease
when curative treatment cannot be clinically viable. The ministry of health and social welfare in
Tanzania has teamed up with the World Health Organization, the global nonprofit Jhpiego, the
global agency for research on cancer, as well as myriad international and global non-
governmental organizations partners to reduce or find sustainable solutions to cervical cancer
in the country. At a basic level, the prevention programming for cervical cancer focuses two
major areas, that is, supply of interventions on the part of healthcare system and creating need
for healthcare services at public and local level. Empirical cognitive knowledge concerning a
disease does not simply lead to need for a healthcare services, however, it is a first step in the
demand of services process.
Etiology of cervical cancer
About three decades ago, human papilloma virus high-risk viruses were recognized as a
causal agent for cervical cancer (Research and Markets 4AD, 2019). HPV infects the metaplastic
epithelium found in the zone of cervical transformation. The continuous infection influences
the epithelium to develop precancerous transformations and ultimately the attack of the basal
membrane act as the final process of the development of cervical cancer. HPV may be detected
in over 99.8% of the adenocarcinomas as well as squamous of the cervix uteri.
Risk factors of cervical cancer
A risk factor is described as anything which alters an individual chance of getting an
illness like cancer. Various cancers have various identified risk factors. For instance, exposing an

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individual’s skin to strong rays of the sun is viewed as a skin cancer risk factor. Smoking on the
other hand is a considered as a risk factor for numerous cancers. However, being exposed to
risk factors, or multiple risk factors, does not necessarily signify an individual will suffer from
the illness. Numerous risk factors enhance the chances of an individual to develop cervical
cancer. Moreover, women who are not having the risk factors barely develop cervical cancer.
Even though the risk factors enhance an individual’s likelihoods of suffering from cervical
cancer, numerous females having the risk factors may not develop the disease. Furthermore,
when a woman gets precancerous changes or cervical cancer, it is not easy to attribute the
cause of such a cervical cancer or precancerous changes a specific risk factor (Gatumo et al.
2018). The risk factors associated with cervical cancer include HPV infection, smoking,
weakened immune system, chlamydia infection, obese or overweight, etc. This paper will
discuss two vital risk factors for cervical cancer.
Sexually transmitted infections as risk factors of cervical cancer
HPV as a risk factor for cervical cancer in Tanzania
Human papilloma virus is considered as the frequent viral infection of the human
reproductive system. Most of the sexually active men and women will be infected at certain in
time of their lives while few can continuously get infected with virus. It should be noted that
the peak period for getting infected with the virus for both female and male is immediately
after getting sexually active. Human papilloma virus is sexually transmitted, nevertheless,
penetrative sexual intercourse is not needed for the virus to be transmitted (Ebrahim et al.
2016). Skin to skin genital contact is the identified transmission mode of the virus. There are

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numerous types of human papilloma virus and numerous are not responsible for causing health
problems. The infection by human papilloma virus normally clear up without any type of
intervention within a short period after infection, as well as about 91% clear up within two
years. cervical cancer is the most frequent HPV-linked illness. almost all cases of related to
cervical cancer are attributed to human papilloma virus. East African countries especially
Tanzania has the highest human papilloma virus DNA prevalence in the entire world with a
confidence interval of 31.8%; 96%, 29.6-33.9 as well as experience the greatest rate of age-
standardized occurrence of cervical cancer of 43 per 100000 women annually (Teame et al.
2018).
Among the cytological standard, HPV negative, women with average age of 18 years,
74% in Tanzania as well as 73% in Uganda were reported to contain a detectable human
papilloma virus DNA of any genotype (Opoku et al. 2016). Human papilloma virus DAN
detection increased drastically after seroconversion of HIV in women infected with HIV relative
to rates of detection over time in women who remained HIV uninfected (Williams et al. 2015).
Human papilloma virus is probably to continue as well as progress to cancer in
immunosuppressed and HIV positive women (Weragoda et al. 2016). There are empirical
evidences that human papilloma virus can be a vital cofactor in infection of HIV in Tanzania.
Even though numerous human papilloma virus clears up by themselves as well as numerous
precancerous lesions work out spontaneously, there are risks for all women especially in East
African countries that human papilloma virus infection can become chronic as well as
precancerous lesions can gradually lead to cervical cancer. It usually talks about 21 years for
cervical cancer to grow in women having normal immune systems. Moreover, it only takes 5-10

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years in women having weakened immune system like those women who are living with HIV
infection.
When women come into contact with the human papilloma virus, their immune system
normally inhibits the virus from doing dangerous harm to the body. nevertheless, in small
number of women, HPV survives and stays in their body for years (Kelly, Allison & Ramaswamy,
2018). ultimately, the virus may result to the conversion of the normal body cells on the surface
of the cervix into cancerous cells. At initial stages, cells may only reveal signs of infection by the
virus. Ultimately, the cells can develop changes which are precancerous in nature, a condition
known as cervical intraepithelial neoplasia, that fades away spontaneously, yet in certain
instances can progress to invasive cervical cancer. It has not been empirically proven why some
women are susceptible to suffering from cervical cancer. Some types of human papilloma virus
are more aggressive relative to others. Being overweight, smoking, prolonged use of
contraceptives is also risk factors of cervical cancer especially for women in Africa.
Chlamydia trachomatis
Chlamydia trachomatis contributes to the enhanced risk of cervical cancer not only in
East Africa but also globally. In a study done about cervical cancer and chlamydia trachomatis, it
was found out that C. trachomatis DNA was found in 41% of invasive squamous cell carcinoma
(Research and Markets 2AD, 2019). The study results of study done in seven countries revealed
that serum antibodies of chlamydia trachomatis are linked with a 1.9-fold rise in risk of cervical
cancer (Jacobs et al. 2014). The risk rises in women having higher antibody titers as well as in
women who are under the age of 55 years. Chlamydia trachomatis infection can enhance the

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risk of cervical cancer by enhancing an individual’s vulnerability to human papilloma virus or by
enhancing human papilloma mediated impacts. It should be noted that inflammation which
happen due to chlamydia trachomatis infection usually result in the production of reactive
oxygen species leading to the DNA damage as well as rise in the human papilloma virus-linked
carcinogenesis.
Sexual and reproductive factors
Multiple sexual partners
An enhanced risk of cervical cancer is seen in individuals having numerous sexual
partners. The increase in risk is normally associated to a rise in risk of HPV infection.
Nevertheless, in an empirical study, it was revealed that the risk of cervical cancer is still high in
women even after controlling for human papilloma virus infection. Thus, other factors can
contribute to the enhanced risk of cervical cancer in individuals having numerous sexual
partners. It should be noted that sexual experience at older age set is suggested to be linked
with reduced age of diagnosis while early age at first sexual intercourse is a risk factor for
cervical cancer.
Oral contraceptive pills
Present and current use of combined oral contraceptive methods in the African
countries especially in Tanzania is linked with an enhanced risk of cervical cancer in women. In a
global collaborative study epidemiological study concerning cervical cancer, the risks in present
users of oral contraceptives rose with an increase in the oral contraceptive duration of use in
African countries (Gibson et al. 2019). It should be noted that it has been empirically revealed

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that the use of OCP methods for over five years can triple the risk of cervical cancer in women.
Nevertheless, there is minor rise in the incidence of cervical cancer in the people who applied
injectable progesterone for over five years. in a study carried among women who positively
tested for HPV DNA, risk of invasive cervical cancer rose by three times of they had previously
used OCP for over five years. Thus, the paper states that the risk of cervical cancer does not
depend on the initial time of consuming OCP.
Parity
Numerous studies have revealed that full-term pregnancy enhances the risk of cervical
cancer in the African countries. Furthermore, high parity enhances the risk of cervical cancer in
women. In a collaborative global clinical study on cervical cancer, a direct link was established
between parity and cervical cancer risks, that is, there was an inverse correlation between age
of a mother at first pregnancy and cervical cancer risks (El Ibrahimi & Pinheiro, 2017). The risk
of cervical cancer has been established with the increase in the number of deliveries a woman
undergoes.
Conclusion
The objective of this paper was to critically explore prevalence of cervical cancer in Sub-
Saharan Africa with the specific country being Tanzania. The paper also explored the role of
numerous risk factors associated with increase in incidence of cervical cancer in Tanzania as
well as the burden linked to cervical cancer. The paper showed that the incidence of cervical
cancer differs greatly between developing and developed nations. The paper found out that
HPV is the greatest risk factor for cervical not only in Tanzania but also in the entire globe.

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chlamydia trachomatis is also responsible for the enhancement in cases of cervical cancer
among women in Tanzania. Having numerous sexual partners also enhances risk of suffering
from cervical while the paper identified parity as also a risk factor for cervical cancer in
Tanzania.

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References
Ebrahim, S, Mndende, XK, Kharsany, ABM, Mbulawa, ZZA, Naranbhai, V, Frohlich, J, Werner, L,
Samsunder, N, Karim, QA & Williamson, A-L 2016, ‘High Burden of Human Papillomavirus (HPV)
Infection among Young Women in KwaZulu-Natal, South Africa’, PLoS ONE, vol. 11, no. 1, pp. 1–
10. Retrieved from https://doi.org/10.1371/journal.pone.0146603
El Ibrahimi, S & Pinheiro, PS 2017, ‘The effect of marriage on stage at diagnosis and survival in
women with cervical cancer’, Psycho-Oncology, vol. 26, no. 5, pp. 704–710. Retrieved from
https://doi.org/10.1002/pon.4070
Gatumo, M, Gacheri, S, Sayed, A-R & Scheibe, A 2018, ‘Women’s knowledge and attitudes
related to cervical cancer and cervical cancer screening in Isiolo and Tharaka Nithi counties,
Kenya: a cross-sectional study’, BMC Cancer, vol. 18, no. 1, pp. 1–9. Retrieved from
https://doi.org/10.1186/s12885-018-4642-9
Gibson, EG, Gage, JC, Castle, PE & Scarinci, IC 2019, ‘Perceived Susceptibility to Cervical Cancer
among African American Women in the Mississippi Delta: Does Adherence to Screening
Matter?’, Women’s Health Issues, vol. 29, no. 1, pp. 38–47. Retrieved from
https://doi.org/10.1016/j.whi.2018.09.006
Jacobs, EA, Rathouz, PJ, Karavolos, K, Everson-Rose, SA, Janssen, I, Kravitz, HM, Lewis, TT &
Powell, LH 2014, ‘Perceived Discrimination Is Associated with Reduced Breast and Cervical
Cancer Screening: The Study of Women’s Health Across the Nation (SWAN)’, Journal of
Women’s Health (15409996), vol. 23, no. 2, pp. 138–145. Retrieved from
https://doi.org/10.1089/jwh.2013.4328

RISK FACTORS FOR CERVICAL CANCER
13
Kelly, PJ, Allison, M & Ramaswamy, M 2018, ‘Cervical cancer screening among incarcerated
women’, PLoS ONE, vol. 13, no. 6, pp. 1–10. Retrieved from
https://doi.org/10.1371/journal.pone.0199220
Le, D & Holt, CL 2018, ‘CervixCheck: A Spiritually-Based Text Messaging Intervention to Promote
Cervical Cancer Awareness and Pap Test Screening Intention among African-American
Women’, Journal of Health Communication, vol. 23, no. 9, pp. 842–853. Retrieved from
https://doi.org/10.1080/10810730.2018.1528317
Maree, JE, Wright, SCD & Makua, TP 2011, ‘Men’s lack of knowledge adds to the cervical cancer
burden in South Africa’, European Journal of Cancer Care, vol. 20, no. 5, pp. 662–668. Retrieved
from https://doi.org/10.1111/j.1365-2354.2011.01250.x
Miri, MR, Moodi, M, Sharif-Zadeh, G-R, Malaki Moghadam, H, Miri, M & Norozi, E 2018,
‘Cognitive predictors of cervical cancer screening’s stages of change among sample of Iranian
women health volunteers: A path analysis’, PLoS ONE, vol. 13, no. 3, pp. 1–11. Retrieved from
https://doi.org/10.1371/journal.pone.0193638
Mwaka, AD, Orach, CG, Were, EM, Lyratzopoulos, G, Wabinga, H & Roland, M 2016, ‘Awareness
of cervical cancer risk factors and symptoms: cross-sectional community survey in post-conflict
northern Uganda’, Health Expectations, vol. 19, no. 4, pp. 854–867. Retrieved from
https://doi.org/10.1111/hex.12382
Opoku, CA, Browne, ENL, Spangenberg, K, Moyer, C, Kolbilla, D & Gold, KJ 2016, ‘Perception and
risk factors for cervical cancer among women in northern Ghana’, Ghana Medical Journal, vol.
50, no. 2, pp. 84–89. Retrieved from https://doi.org/10.4314/gmj.v50i2.6

RISK FACTORS FOR CERVICAL CANCER
14
PR Newswire 2018, ‘Snapchat Subscription Platform Baecash Announces Fundraiser to Provide
100 HPV Vaccines to Nigerian Women in Early Stages of Cervical Cancer’, PR Newswire US, 11
January. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=bwh&AN=201801110845PR.NEWS.USPR.PH85940&site=ehost-live
Research and Markets 2AD, 2019, ‘Worldwide Cervical Cancer Treatment Market Size & Share
to 2026, Featuring Profiles for Key Players - ResearchAndMarkets.com’, Business Wire (English),
2019 June. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=bwh&AN=bizwire.c87907186&site=ehost-live
Research and Markets 4AD, 2019, ‘Global Cervical Cancer Diagnostics & Therapeutics Market
Forecasts to 2024 - ResearchAndMarkets.com’, Business Wire (English), 2019 Spring. Retrieved
from http://search.ebscohost.com/login.aspx?
direct=true&db=bwh&AN=bizwire.c88720100&site=ehost-live
Teame, H, Addissie, A, Ayele, W, Hirpa, S, Gebremariam, A, Gebreheat, G & Jemal, A 2018,
‘Factors associated with cervical precancerous lesions among women screened for cervical
cancer in Addis Ababa, Ethiopia: A case control study’, PLoS ONE, vol. 13, no. 1, pp. 1–13.
Retrieved from https://doi.org/10.1371/journal.pone.0191506
Teame, H, Gebremariam, L, Kahsay, T, Berhe, K, Gebreheat, G & Gebremariam, G 2019, ‘Factors
affecting utilization of cervical cancer screening services among women attending public
hospitals in Tigray region, Ethiopia, 2018; Case control study’, PLoS ONE, vol. 14, no. 3, pp. 1–
11. Retrieved from https://doi.org/10.1371/journal.pone.0213546

RISK FACTORS FOR CERVICAL CANCER
15
Weragoda, J, Azuero, A, Badiga, S, Bell, WC, Matthews, R & Piyathilake, C 2016, ‘An examination
of racial differences in 5-year survival of cervical cancer among African American and white
American women in the southeastern US from 1985 to 2010’, Cancer Medicine, vol. 5, no. 8, pp.
2126–2135. Retrieved from https://doi.org/10.1002/cam4.765
Williams, M, Moneyham, L, Kempf, M-C, Chamot, E & Scarinci, I 2015, ‘Structural and
Sociocultural Factors Associated with Cervical Cancer Screening Among HIV-Infected African
American Women in Alabama’, AIDS Patient Care & STDs, vol. 29, no. 1, pp. 13–19. Retrieved
from https://doi.org/10.1089/apc.2014.0063
Zorogastua, K, Sriphanlop, P, Reich, A, Aly, S, Cisse, A & Jandorf, L 2017, ‘Breast and Cervical
Cancer Screening among US and non US Born African American Muslim Women in New York
City’, AIMS Public Health, vol. 4, no. 1, pp. 78–93. Retrieved from
https://doi.org/10.3934/publichealth.2017.1.78