Cervical Cancer: Not Just HPV, Here’s How Lifestyle, Immunity and Inequity Play a Role
While HPV is the leading cause of cervical cancer, lifestyle, immunity, and reproductive factors also play a major role — especially in India, where the burden is uneven and rising.
When caught early through routine screening, cervical cancer is curable. While nearly all cervical cancer cases are linked to Human Papillomavirus (HPV) infection, experts emphasise that the disease is influenced by a range of intersecting lifestyle, sexual, and biological factors. New insights highlight why prevention must go beyond just vaccination—and why India, in particular, needs urgent, focused intervention.
“Sexual history, lifestyle habits, immune health, and reproductive patterns all play a role in cervical cancer risk,” explains Dr. Yukio Sonoda, MD, FACOG, FACS, and Gynaecologic Surgeon at Memorial Sloan Kettering Cancer Center, New York, US.
What is cervical cancer?
Cervical cancer is a type of cancer that occurs in the cervix — the lower, narrow part of the uterus that connects to the vagina. It develops when abnormal cells in the cervix grow uncontrollably, often (though not always) triggered by persistent infection with high-risk types of Human Papillomavirus (HPV).
In the US, roughly 92% of women with early-stage cervical cancer survive five years or longer, compared with only 17% of women with late-stage cervical cancer, says a Harvard report. One may wonder, why should statistics of the US send us in India worrying about the cervical cancer scenario here?
India’s Alarming Cervical Cancer Burden
A recent study published by the Indian Council of Medical Research (ICMR) revealed that cervical cancer remains India’s second most common cancer, with a troubling regional disparity in disease burden. Using data from the National Cancer Registry Programme, the study estimated the national burden in 2016 at 223.8 DALYs per 100,000 women — a number projected to rise to 1.5 million DALYs by 2025.
What is DALY?
DALY, or Disability-Adjusted Life Year, is a public health metric used to measure the overall burden of disease. It combines two key components: YLLs (Years of Life Lost) due to premature death; and YLDs (Years Lived with Disability) due to living with the disease or its complications.
In simple terms: 1 DALY = 1 lost year of healthy life.
So, when a report says India will have 1.5 million DALYs due to cervical cancer by 2025, it means 1.5 million years of healthy life will be lost across the population due to death and disability caused by the disease. It's a powerful way to capture not just how deadly a condition is, but also how much it affects quality of life.
The northeast, particularly Mizoram, Nagaland, Arunachal Pradesh, and Karnataka, reported DALY rates exceeding 300 per 100,000 women, underlining the urgent need for state-level screening and vaccination drives.
Dr. Yukio Sonoda says that while HPV (Human Papillomavirus) infection causes approximately 99% of cervical cancer cases, a complex interplay of various risk factors influences its development and progression. Understanding these multifaceted risks is crucial for effective prevention and early detection.
Beyond the Virus: What Increases the Risk?
For years, the Pap smear test was the primary tool for cervical cancer screening. But the discovery that certain high-risk strains of HPV cause most cervical cancers has shifted the focus to HPV testing, and also considering other factors for more accurate early detection.
Early Sexual Activity and High-Risk Partners: The risk increases for women who become sexually active before 18 or have multiple partners. Even having a partner with a high-risk sexual history raises HPV exposure, warns Dr. Sonoda.
Smoking Doubles the Risk: “Smoking allows harmful tobacco by-products to damage cervical cells and weakens immune defences against HPV,” he explains. Smokers face double the risk compared to non-smokers.
Immune Compromise and Co-Infections: Women with weakened immune systems—due to HIV, immunosuppressive therapy, or chronic conditions—struggle to clear HPV infections effectively. Co-infections like chlamydia may also allow HPV to persist longer in the cervix, increasing cancer risk.
Contraceptive Use and Reproductive History: Long-term use of oral contraceptives (beyond five years) and having three or more full-term pregnancies, or one before the age of 20, can modestly increase cervical cancer risk, likely due to hormonal and immune changes.
Prevention — The Indian Imperative: The ICMR study underscores that enhancing awareness, strengthening screening coverage, and promoting HPV vaccination among adolescents must be India’s top priorities. Yet, challenges like taboos around gynaecological exams, low rural outreach, and poor follow-up rates remain obstacles.
“Cervical cancer prevention should address multiple risk factors simultaneously,” says Dr. Sonoda. “Screening, safe sex, smoking cessation, and paying attention to early warning signs—like abnormal bleeding, discharge or pelvic pain—are all part of the puzzle.”
Vaccination is essential, but not a standalone solution. Regular Pap smears and HPV testing, paired with open conversations around reproductive health and robust community outreach, can turn the tide in India's battle against cervical cancer.
Kirti Pandey is a senior independent writer.
[Disclaimer: The information provided in the article, including treatment suggestions shared by doctors, is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.]
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