Cervical cancer: a history of treatment and prevention

In the UK, the vast majority of cervical cancer cases are caused by high-risk strains of the human papillomavirus (HPV). Infection is common, but for most people it doesn’t cause any problems – the infection will get better on its own and they will never know they had it. HPV spreads through close skin-to-skin contact, usually during sexual activity including oral sex.

How does it start?

Between 2014 and 2016, around 3,200 UK women were diagnosed with cervical cancer each year – that’s around nine new cases every day. Unlike most other cancer types, where risk increases with age, the rates of cervical cancer are highest in the 25-29 age group, and more than half of cases are in women under 45.

Who’s affected?

Thanks to the work of Cancer Research UK and others, the introduction of a national HPV vaccination programme and a cervical screening programme means that many cervical cancers are prevented before they even have chance to develop. But for the 3,200 that do develop each year in the UK, there’s still more work to be done. From studying the biology of cervical cancer cells in the lab to leading clinical trials testing new treatments, Cancer Research UK scientists are working hard to ensure more women survive cervical cancer.

What is Cancer Research UK doing about it?

The timeline:

Charting cancer successes within living memory

1988

National screening for cervical cancer begins

[Sigmoidoscopy]

1990s

HPV is identified as the cause of 99 per cent of cervical cancer cases

[Dr Cuthbert Dukes]

2008

Rollout of national HPV vaccination for girls

In 2008, a national vaccination programme began that could one day make cervical cancer a rarity. Girls aged between 11 and 13 are given the HPV vaccine – which has been thoroughly clinically tested, and shown to be safe and effective – in year 8 of school, followed by a second dose six to 12 months later. To date, 10.5 million doses have been given. The current vaccine protects against two high-risk types of HPV – 16 and 18 – which has been shown to be responsible for more than 70 per cent of cervical cancer cases, along with several other types of cancer such as head and neck, vulval, vaginal, anal and penile cancers. The vaccine also protects against two other types of HPV – 6 and 11 – which cause 90 per cent of genital warts. “Vaccinating significantly reduces the risk of cervical cancer because it protects against the high-risk types of HPV that cause the majority of cervical cancer cases,” says Katie Edmunds, health information manager at Cancer Research UK. It’s given before most girls are sexually active so that they’re protected before they’re exposed to any strains of HPV.

Women today are used to receiving their cervical screening invitations, but this opportunity for regular screening only began in 1988. Cancer Research UK ran some of the earliest studies on cervical screening in the 1950s and helped to prove its value, laying the path towards today’s screening programme. Its success has been incredible, reversing a rising trend in cervical cancer deaths. In the 20 years between 1967 and 1987, deaths from cervical cancer in England and Wales in women under 35 rose three-fold, according to a study in The Lancet. By 1988, rates of death in that age range were among the highest in the world.

In the 1990s, Cancer Research UK scientists teamed up with others to carry out groundbreaking research on the human papillomavirus (HPV) and discovered that it causes the vast majority of cervical cancers worldwide. There are more than 100 types of HPV and the majority of us (about eight in 10) will have been infected with it at some point in our lives. It often causes no harm or symptoms, and the body eventually clears it. However, there are about 13 types of high-risk HPV that can cause cell changes that could ultimately lead to cancer.

My cervical cancer journey

Justine Harris, 31, an aesthetic practitioner from Birmingham, was diagnosed with cervical cancer at 29

“I have three sons, aged 14, nine and five. When I was pregnant with my youngest, I had bleeding on and off throughout the pregnancy, but it was put down to a cervical ectropion (a non-cancerous condition on the outside surface of the cervix). The symptoms stopped as soon as I had my son, so I didn’t think anything more of it. “Six months after he was born, I had a letter calling me in for my routine smear. I always went for the appointment immediately because my cousin passed away from cervical cancer when I was 14. That smear showed that the ectropion was still there, but it was nothing to worry about. “Three years later, I was called for my next smear but, this time, the results came back showing some abnormal cells. I was referred to the hospital to have laser treatment to remove the cells and they were sent off for testing. I wasn’t too worried as the consultant thought the cells looked OK, but I was called back in to see him within a week and he broke the awful news that the cells were cancerous.

‘I wish I'd had the chance to be vaccinated against HPV’

“Fortunately, they had caught it early and it was stage 1B1 (meaning that the cancer had not spread beyond the cervix and was no larger than 4cm). I felt terrified, mainly because of my children and thinking about what they would do without a mother, but the hospital staff were so kind and reassuring, talking me through everything that was about to happen. “Four weeks later, I had a hysterectomy but the surgeon preserved my ovaries so that I didn’t go into early menopause. I had tests on my lymph nodes, which showed that the cancer hadn’t spread, so I was spared chemotherapy and radiotherapy. I had a little bit of nerve damage afterwards and put on weight because I couldn’t exercise, but I was so grateful that the cancer had been taken out of me that I didn’t really care. “I think that the HPV vaccine is an amazing advance. I wish that I’d had the opportunity to be vaccinated at 13 to save this happening to me – I would have jumped at the chance, especially after losing my cousin. If I had a daughter, she’d be first in line for the vaccination and my boys will all be vaccinated now that it’s going to be rolled out to boys too.

1923

Research into radiation as treatment for cervical cancer

Cancer Research UK awarded its first grants for the purchase of radium to treat cervical cancer in this year, and also funded the work of radiotherapy pioneers

What is radiotherapy?

Radiotherapy is used to treat cancer or prevent its return. Around 40 per cent of cervical cancer patients will be given this form of treatment. It works by using radiation, usually X-rays, to destroy cancer cells by damaging their DNA. But radiotherapy is indiscriminate: the beam of radiation can also affect healthy cells, which can

Symptoms of cervical cancer

With more than 200 different types of cancer, it’s not possible to learn all the possible symptoms. The key is to get to know what’s normal for you, and if you notice anything unusual or anything that sticks around for a while, visit your GP and get it checked out, even if you’ve just been for screening or you have one booked in soon. Most of the time it won’t be cancer but it’s important to get checked out.

What to look for

Vaginal bleeding during or after sex

Bleeding after the menopause

Bleeding between periods

Changes to your vaginal discharge

Reduce your risk

More than half of bowel cancers could be prevented in the UK. Here are some of the positive steps you can take to reduce your risk:

Cut back on red and processed meat.

The less you eat, the lower your risk. Consider taking meat-free days or switching to recipes that use fresh chicken or fish instead.

Eat more high-fibre foods.

Such as wholegrains, nuts, seeds, oats, beans and lentils. It’s thought that fibre helps prevent bowel cancer in several ways, including improving the transit of food through your digestive system.

Maintain a healthy weight.

Fat cells produce more hormones and growth factors which can cause cells to divide more quickly, raising the risk of bowel and other cancers.

Drink less alcohol.

Alcohol consumption produces harmful chemicals that can damage cells. No type of alcohol is better or worse than another: it’s the total amount you drink that counts. The less you drink, the lower your risk.

Stop smoking.

The chemicals in cigarettes increase the risk of 15 different cancers, including bowel cancer. Free stop-smoking services have been shown to roughly triple the likelihood of success compared to going “cold turkey” alone. Talk to your doctor or pharmacist, and visit the NHS Smokefree website to find out what will work for you.

Stay active.

Regular exercise can help you keep a healthy weight, which reduces the risk of 13 different types of cancer. And if you’re doing a lot of physical activity, it can help reduce the risk of bowel cancer directly by keeping your digestive system working efficiently and reducing inflammation.

Donate today to help Cancer Research UK make more incredible strides forward in diagnosis, prevention and treatment of cancer. No matter how small or large, your gift will lead to dramatic changes to cancer outcomes in your lifetime. For example:

£40 could pay for a cancer biopsy, where a tiny sample of someone’s tumour is taken for research

£250 could buy 500 plastic dishes, essential for scientists to grow and study cells in the lab

£1,000 could help fund a clinical trial of a new, more effective treatment for cervical cancer

Join Cancer Research UK on its mission towards the day when all cancers are cured.

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How Cancer Research UK plans to tackle cervical cancer

99.8%

of cervical cancer cases in the UK are preventable

90%

Almost

Over the past decade, cervical cancer mortality rates have decreased by around a quarter (24%) in the UK

90%

of women with cervical cancer will survive their disease for five years or more in England

When diagnosed at its earliest stage, around

Bowel cancer incidence is projected to fall by 11 per cent by 2035. Here are just a few examples of the work that’s going on to help achieve this, and to improve treatments for those who do develop the disease.

Boys will get the HPV vaccine

From September 2019, the HPV vaccine will also become available to boys, which will help prevent more cases of HPV-related cancers in both sexes. Boys in year 8 will be vaccinated with a second dose six months to a year later. This will also help protect men who have sex with men, who do not currently benefit from herd immunity.

At-home testing kits could happen

“The introduction of testing for HPV first, rather than cell changes, opens up the possibility of DIY testing kits that people can use at home,” says Professor Waller. “This could be a really great development for people who are unwilling or unable to go to their GP surgery for standard screening. It would be like a long cotton bud that people can use to take a vaginal swab, with no need for a speculum, and then it would be posted to the lab.”

A new vaccine could emerge to prevent recurrence

Saving lives in our lifetime: Cervical cancer

Effective screening and a nationwide vaccination programme are further advancing our progress towards a future where cervical cancer is a rarity. This long read explores how this rapid progress has occurred within living memory

JUMP TO

Timeline

Case Study

Symptoms

Prevention

The cervix is the lower part of the womb, also called the neck of the womb. Cervical cancer occurs when abnormal cells in the lining of the cervix grow in an uncontrolled way. In women, it’s the 14th most common cancer and accounts for 2 per cent of all new cancer cases.

What is it?

Produced by Telegraph Spark Words Caroline Roberts Commissioning Editor Jess Spiring Sub-Editor Loveday Cuming Designer Sandra Hiralal Digital Developer Pedro Hernandez Picture Editor Emma Copestake Web Producer Katherine Scott Project Manager Alex Brooksbank

Cancer Research UK is supporting an early-stage clinical trial investigating a new type of vaccine called RNA, which is designed to help the immune system recognise and attack a type of HPV called HPV16. It is hoped that this vaccine could one day be used to help prevent HPV16-related cancers coming back after treatment, including some cervical cancers.

The most common symptoms include:

Could a breath test detect cancer in the future?

What does the future of cancer research look like?

Scientists say ‘thank you’ to cancer trial participants

Related content

Saving lives in our lifetime: Cervical cancer

“This will ultimately create herd immunity from the high-risk types of HPV because the virus has less opportunity to pass from person to person. We already have good data that the rates of HPV infection have been much reduced.” Since the introduction of the vaccine, the number of cases of HPV 16/18 infection has gone down by 86 per cent, according to Public Health England. “The vaccination programme hasn’t been going for long enough for us to see a drop in cervical cancer because the disease takes time to develop, but we should start to see rates dropping in the future,” says Miss Edmunds. “Boys also benefit from girls being vaccinated because there’s less risk of being exposed to the high-risk HPV types that can cause cancers in men and they’re also protected from genital warts.” It may also mean that some vaccinated women could one day have fewer cervical screens to get the same benefit. “Current modelling shows that it could be as few as three times over their lifespan compared with the current 12,” says Miss Edmunds.

This amazing discovery meant that scientists could turn their attention to creating a vaccine against the virus to help prevent cervical cancer. In the early 2000s, a prototype vaccine developed by Cancer Research UK scientists was given in an early trial to women with cervical abnormalities. This and further trials showed that these vaccines could stimulate the immune system to prevent HPV infection. That important work contributed to the development of the current vaccine and the existence of the vaccination programme we have today, which could cut the number of cases of cervical cancer and prevent thousands of deaths.

But the introduction of screening means that one in 80 British women born between 1951 and 1970 will be saved from premature death. Cervical screening is for people without symptoms. It is offered to women between the ages of 25 and 64 – every three years until age 49, and then every five years until age 64. You need to be registered with a GP to be invited. Anyone with a cervix is eligible for cervical screening – this includes women, trans-men and people who are intersex or non-binary.

including Hal Gray and William Valentine Mayneord. They showed how cancer cells respond to radiation and established guiding principles for its use.

lead to side effects during and after treatment. Cancer Research UK scientists are working to make radiotherapy even more effective and to reduce its side effects by, for example, refining the target of radiation – boosting treatment to the tumour but sparing the surrounding tissue.

[Dr Cuthbert Dukes]

A shift to HPV primary screening

current way of screening.” If there are cell changes, you will be invited for a colposcopy (a more detailed examination of the cervix); if you have HPV but no cell changes, you will be invited back for screening sooner than is standard. “It’s important to understand that HPV is transmitted by skin-to-skin sexual contact with a man or woman, not just penetrative sex,” says Professor Waller. “That’s a misconception that can stop people attending screening because they believe they’re at little or no risk of HPV.” This new way of screening has been piloted in England since 2013; it is already in place in Wales and will gradually be rolled out across the UK over the next few years.

2019

Seven ways to make your cervical screen more comfortable

Wanda Scrivener, Cancer Research UK’s cancer information nurse, has carried out thousands of smear tests. Here’s her advice…

If it’s your first cervical screen or you’re nervous after a previous one, book a double appointment to allow time to talk to the nurse and not feel any pressure. Also take leaflets home with you as they can help you absorb information you might not remember from the appointment if you’re nervous.

Don’t hesitate to tell the nurse to stop if it’s uncomfortable or you want to change position. Sometimes placing your hands under your bottom can make it easier and we also have several different sizes of speculum, so you can ask for a smaller one.

Wear comfortable clothes that are easy to get on and off. If you’d rather not take your trousers off, wear a skirt and then you can just pull it up.

Bring someone along. If you feel you need some moral support, it’s perfectly fine to take someone with you. They don’t have to be inside the curtain, but will at least be there in the room and afterwards.

I’ve always found that people find it easier if they’re relaxed and distracted – listening to music on headphones can really help.

Ask how long the results will take to come through. This can vary from area to area and it will prevent you from fretting.

Last, but certainly not least, never feel embarrassed about any aspect of your genitalia. Nurses are professionals and are only interested in your health.

Even if you notice a change that isn’t on the list, talk to your doctor.

£2 million

In 2018/19, Cancer Research UK spent

on cervical cancer research

90%

Almost

Cervical cancer is the 14th most common cancer in UK women

2019

A SHIFT TO HPV PRIMARY SCREENING

This year will see a change in the way the NHS screens for cervical cancer. “Currently, the screening is a test to look for abnormal cell changes that have occurred as a result of the HPV virus,” says Professor Jo Waller, professorial research fellow at University College London. “But this year, the NHS programme is moving over to testing for high-risk strains of HPV first, as we know that HPV infection is the very first step in the development of cervical cancer. If a person tests positive for HPV, their sample will then be checked for abnormal cell changes. It’s a more sensitive test than the current way of screening.” If there are cell changes, you will be invited for a colposcopy (a more detailed examination of the cervix); if you have HPV but no cell changes, you will be invited back for screening sooner than is standard. “It’s important to understand that HPV is transmitted by skin-to-skin sexual contact with a man or woman, not just penetrative sex,” says Professor Waller. “That’s a misconception that can stop people attending screening because they believe they’re at little or no risk of HPV.” This new way of screening has been piloted in England since 2013; it is already in place in Wales and will gradually be rolled out across the UK over the next few years.

Even if you notice a change that isn’t on the list, talk to your doctor.

THE FUTURE:

How Cancer Research UK plans to tackle cervical cancer

The future

cervix?

where is the