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Almost all cases of cervical cancer occur in women who have been infected with human papillomavirus (HPV). HPV is transmitted through sexual contact and over 80% of women contract it at some time in their lives. In Spain, it is estimated that 14% of women aged 18–65 have HPV. The greatest incidence is observed among women in their first few years of sexual activity (the prevalence is 20–30% for women under the age of 30).
HPV corresponds to a family of over 100 viruses (designated by numbers), of which only 14 types produce precancerous lesions and cervical cancer (called high-risk oncogenic types of HPV). HPV16 and HPV18 have the greatest malignant potential and are responsible for 70% of all cervical cancers.
HPV infection does not manifest any symptoms, on average it lasts for 2 years and in 80–90% of cases it resolves itself without treatment. Only women with persistent HPV infection are at risk of developing cervical cancer.
HPV is a prerequisite for developing cervical cancer, but it is not enough on its own. In other words, cervical cancer is a relatively rare consequence of a very common sexually transmitted disease.
HPV-negative cervical cancers make up less than 1–2% of all cases and often correspond to less commonly encountered types of cervical cancer (adenocarcinomas).
The main risk factor for cervical cancer is the presence of a persistent HPV infection which the body’s defences are unable to eliminate over time.
This long-lasting persistence (rather than the actual infection) is the most significant risk factor associated with the appearance of precancerous lesions. HPV infection can reappear spontaneously, persist or, if it goes undiagnosed or does not receive the correct treatment, it can evolve and transform into cervical cancer.
Various factors (also known as cofactors) contribute to the persistence of HPV infection, that is, they increase the chance of HPV persisting over time and therefore the risk of developing cervical cancer. The main cofactors are:
Type of HPV. Types 16 and 18 are the most aggressive strains, have a greater capacity to become persistent and lead to most cases of CC.
Immunosuppression or reduced defences due to illnesses such as HIV or the administration of immunosuppressants in organ-transplant patients or those with autoimmune or rheumatic diseases, etc.