Smoking and cervical cancer: Is there a link?

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Smoking is not the main cause of cervical cancer, but it does increase the risk.

The main cause of cervical cancer is HPV. The term “HPV” refers to a group of viruses. Many people contract at least one of these at least once during their lifetime. In most cases, the infection causes no symptoms and does not raise the risk of cervical cancer. Usually, the body clears the infection on its own.

However, some types of HPV do raise the risk of cervical cancer, and approximately 1% of women with HPV go on to develop this cancer.

Invasive cervical cancer is 2–3 times more prevalent among women who currently smoke or have smoked. The risk rises with the duration and intensity of smoking. Exposure to secondhand smoke, or “passive smoking,” also increases the risk, though to a lesser extent.

This effect may not be exclusive to tobacco smoke. A 2011 study notes that long-term exposure to wood smoke may also raise the risk. However, no high-quality follow-up studies have confirmed or dispelled this finding. More research is necessary.

Scientists do not entirely understand how smoking increases the risk of cervical cancer, but there are several theories. One hypothesis is that carcinogens in tobacco smoke cause DNA damage, which then contributes to the development of cervical cancer.

Research from 2011 argues that long-term nicotine exposure may cause physiological effects that raise the likelihood of any cancer, such as increased cell multiplication and suppressed apoptosis, which is the normal death of cells.

Another theory is that smoke suppresses the immune response to HPV. People who smoke have fewer white blood cells that fight infections, which might make the immune system less capable of protecting the body from HPV.

Quitting smoking can help a person’s immune system fight HPV. If someone smokes and has a positive HPV test, it is particularly important that they quit.

Stopping smoking may not make HPV go away immediately or completely, but some research suggests that it may reduce the impact of HPV on the body.

A 2009 study looked at the relationship between smoking and HPV’s viral load. This is a measurement of how much of a virus is in the body.

The researchers found that the HPV viral load in women who currently smoke is higher than it is in women who no longer smoke. This suggests that smoking makes it easier for HPV to multiply, and quitting may reverse this.

Learn what happens to the body after quitting.

In addition to HPV and smoking, the following factors raise the risk of cervical cancer:

• Not having the HPV vaccine: This safe, effective vaccine protects against the types of HPV that cause 80–90% of cervical cancer cases. Not having it increases the risk of contracting a type of HPV that could cause cancer.
• Suppressed immune system: People may have weakened or suppressed immune systems due to HIV, immunosuppressant drugs, or other factors. They are more vulnerable to HPV, and so to cervical cancer.
• Sexual activity: HPV passes from person to person mainly through sexual contact. People who have sex from a younger age or have more partners are statistically more likely to contract HPV.
• Multiple pregnancies: This can make a person more likely to develop cervical cancer, though the link is unclear.
• Long-term use of birth control pills: For people with HPV, taking oral birth control for 5 or more years raises the risk of cervical cancer. The risk reduces if a person stops taking the pills.
• Chlamydia: Some research suggests that the bacteria behind this common sexually transmitted infection allows HPV to multiply on the cervix.
• Diethylstilbestrol exposure: Doctors prescribed this synthetic estrogen to pregnant people in the United States from 1938–1971 to prevent premature labor and pregnancy loss. Female children born to people who took the medication during pregnancy have an increased risk of cervical cancer.
• Genetics: Cervical cancer runs in some families. If a close female relative has had cervical cancer, it raises the risk for other female family members. Research indicates that, in rare cases, this is linked to a condition that hinders the ability to fight HPV.

The Centers for Disease Control and Prevention (CDC) recommend that people do the following to lower their cervical cancer risk:

• Getting the HPV vaccine: This is the most important way to reduce the risk. The vaccine prevents new HPV infections, though it does not treat existing ones.
• Having regular screenings: Even a person who has gotten the vaccine should have regular screenings for HPV and cervical cancer. These screenings, called Pap smears, can detect precancerous cells on the cervix, allowing a doctor to remove them and prevent the cancer from developing.
• Not smoking: People who have never smoked should avoid it, and people who currently smoke should try to work toward quitting. The CDC, the American Lung Association, and many other health authorities provide support and tips.
• Using condoms during sex: Using a barrier method of contraception during all sexual activity may prevent HPV from passing from one person to another. However, condoms do not cover all the skin on which HPV might live, so this is not a completely reliable method.
• Limiting sexual partners: If a person wants to, they can also lower their risk of contracting HPV by reducing their number of partners or practicing a form of abstinence. This might involve having no sex of any kind or only abstaining from certain types of sex.

Find 11 tips for quitting smoking here.

Smoking raises the risk of cervical cancer. It may cause DNA damage that increases the likelihood of cancerous changes to cells. Or it may reduce the ability of the immune system to clear HPV from the body.

HPV is the main cause of cervical cancer, so getting vaccinated against it and having regular screenings called Pap smears are the most effective ways to reduce the risk. Stopping smoking and using barrier contraception are also important.