Our impact on cervical cancer

Erica HansonThanks to the generosity of our supporters, research into cervical cancer has prevented many thousands of UK women from being diagnosed with the disease, as well as saving lives by improving survival.

Back in the 1970s, fewer than half of the women with cervical cancer survived for more than 10 years. Today, around two thirds survive. This includes Erica Hanson (right) who was diagnosed with cervical cancer in 2008 and treated with chemotherapy and radiotherapy - a treatment Cancer Research UK helped to pioneer.

Our scientists made pioneering steps towards understanding the causes of cervical cancer, as well as finding ways to prevent and treat it – including vaccines that could, in combination with screening, virtually eliminate the disease. And thousands of lives are saved every year by the UK-wide cervical screening programme, which we helped to develop.

Here are just some examples of the impact we’ve made in beating cervical cancer, and our life-saving research still continues today.

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Understanding the causes

Virtually all cases of cervical cancer are caused by the human papillomavirus (HPV), which is transmitted by sexual contact. HPV infection is very common, but most women carrying the virus will not develop cancer.

Working with others, we showed that HPV was the prime cause of cervical cancer worldwide - more than 99 per cent of cervical tumours in women from 22 countries were found to contain the virus. This discovery overturned previous studies that had underplayed the link.1

Our researchers continued to investigate the links between HPV infection and cervical cancer,2as well as uncovering lifestyle factors linked to HPV infection and cervical cancer, particularly having a high number of sexual partners and starting to have sex at a younger age.3 Our scientists also highlighted the fact that smoking increases the chances of developing cervical cancer,4,5 and that taking the contraceptive pill can also increase the risk.6

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Screening success

Cervical screening (also known as the ‘smear test’) detects pre-cancerous changes as well as cancer cells in the cervix. This means that in the vast majority of cases, screening and prompt treatment actually prevents the development of cancer. As a result, the rates of cervical cancer have plummeted in the UK over the last 20 years.

Back in the 1950s, our researchers carried out some of the earliest studies of cervical screening in the UK, laying the foundations for the screening programme we have today.7With others, we pushed for the introduction of a computerised “call and recall” system in the early 1980s, ensuring that all eligible women could benefit from screening, avoiding many thousands of preventable deaths each year. 8

Since then, our researchers have played a key role in assessing the impact of the national screening programme, helping to maximise the benefits and minimise any potential harms. And our research led to the development of clear information about the advantages and disadvantages of cervical screening, the screening procedure itself, and the meaning of the test results.9

In 2004, our scientists calculated what would have happened if the UK had not introduced a screening programme. They showed that the cervical screening programme has been one of the most effective cancer prevention measures ever introduced, saving the UK from an epidemic of cervical cancer and avoiding many thousands of deaths each year.10

Our researchers are still working hard to improve cervical screening for women in the UK. They have discovered that the cervical screening programme could be improved by testing for HPV in women who have abnormal or borderline test results. 11,12 Following successful pilot trials, HPV testing is due to be introduced across in the UK in future, helping to improve the effectiveness of screening.

We’re also looking at alternative approaches for detecting cervical cancer. In the 1990s, our researchers revealed that proteins called MCMs are found at high levels in cervical cancer, as well as other types of cancer.13 Clinical trials are currently underway to see if testing for MCM proteins can increase the effectiveness of screening for cervical cancer.14

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Preventing cervical cancer

We funded pioneering studies that paved the way for the development of the cervical cancer vaccine that is now available for girls and young women in the UK.15,16,17,18,19, Experts now believe the vaccine could slash the number of cases of cervical cancer from around 3,000 per year to fewer than 700. 20,21

Our researchers were involved in a large scale clinical trial of Cervarix – the vaccine that is now used in the UK.22 The trial involved 18,000 girls and young women, showing that it could cut the chances of developing cervical cancer. And scientists at our Health Behaviour Research Centre showed that three quarters of mothers wanted their daughters to receive the protective vaccine.23

Together, HPV vaccination and testing could dramatically cut the number of cases of cervical cancer in future, and also reduce the number of smear tests a woman will need in her lifetime.

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Pioneering radiotherapy and lifesaving treatment

As long ago as 1923 we funded research to develop radiotherapy for cervical cancer, including the very first research grants awarded by The Cancer Research Campaign - one of the predecessors of Cancer Research UK. These went to the Middlesex Hospital and the Cancer Hospital in Fulham (now known as the Royal Marsden) for treating cervical cancer with the radioactive element radium.

These studies were vital early steps in the development of radiotherapy, now used to successfully treat many thousands of women with cervical cancer around the world.

Although many women with cervical cancer are treated with surgery and radiotherapy, some receive chemotherapy or chemoradiation – combined chemotherapy and radiotherapy. The most commonly used drug for this treatment is cisplatin, which was first shown by our scientists to have anti-cancer activity back in the 1970s.24

Thanks to many years of dedicated research, our scientists have made a significant impact in preventing, detecting and treating cervical cancer – research that continues today.

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References

  1. Wallboomers, JM et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 189, 12-19 (1999)  
  2. Peto J. et al Cervical HPV infection and neoplasia in a large population-based prospective study: the Manchester cohort. Br J Cancer. 2004 Aug 31;91(5):942-53.
  3. Deacon JM et al Sexual behaviour and smoking as determinants of cervical HPV infection and of CIN3 among those infected: a case-control study nested within the Manchester cohort.Br J Cancer. 2000 Dec;83(11):1565-72.
  4. International Collaboration of Epidemiological Studies of Cervical Cancer et al Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer. 2006 Mar 15;118(6):1481-95.  
  5. Collins S et al Cigarette smoking is an independent risk factor for cervical intraepithelial neoplasia in young women: a longitudinal study Eur J Cancer. 2010 Jan;46(2):405-11.  
  6. International Collaboration of Epidemiological Studies of Cervical Cancer et al Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet 2007 Nov 10;370(9599):1609-21.  
  7. Wachtel E. A suggestion for a cytological test of cancer cure. J Obstet Gynaecol Br Emp. 1956 Apr;63(2):176-8.  
  8. Organisation of a programme for cervical cancer screening. ICRF coordinating committee on cervical screening. Br Med J (Clin Res Ed). 1984 Oct 6;289(6449):894-5.  
  9. Davey C et al Improving written information for women about cervical screening: evidence-based criteria for the content of letters and leaflets. Health Education Journal 1998 vol. 57 no. 3 263-281  
  10. Peto J et al The cervical cancer epidemic that screening has prevented in the UK. Lancet. 2004 Jul 17-23;364(9430):249-56.  
  11. Cuzick J et al Management of women who test positive for high-risk types of human papillomavirus: the HART study. Lancet. 2003 Dec 6;362(9399):1871-6.  
  12. Mesher D et al Long-term follow-up of cervical disease in women screened by cytology and HPV testing: results from the HART study. Br J Cancer. 2010 Apr 27;102(9):1405-10.  
  13. Williams GH et al Improved cervical smear assessment using antibodies against proteins that regulate DNA replication. Proc Natl Acad Sci U S A. 1998 Dec 8;95(25):14932-7.  
  14. Mukherjee G et al MCM immunocytochemistry as a first line cervical screening test in developing countries: a prospective cohort study in a regional cancer centre in India. Br J Cancer. 2007 Apr 10;96(7):1107-11.  
  15. Jarrett WF et al Studies on vaccination against papillomaviruses: prophylactic and therapeutic vaccination with recombinant structural proteins. Virology. 1991 Sep;184(1):33-42.  
  16. Campo MS et al A peptide encoding a B-cell epitope from the N-terminus of the capsid protein L2 of bovine papillomavirus-4 prevents disease. Virology. 1997 Aug 4;234(2):261-6.  
  17. Kirnbauer R et al Virus-like particles of bovine papillomavirus type 4 in prophylactic and therapeutic immunization. Virology. 1996 May 1;219(1):37-44.  
  18. Zhou J et al Increased antibody responses to human papillomavirus type 16 L1 protein expressed by recombinant vaccinia virus lacking serine protease inhibitor genes. J Gen Virol. 1990 Sep;71 ( Pt 9):2185-90.  
  19. Sadovnikova E et al Limitations of predictive motifs revealed by cytotoxic T lymphocyte epitope mapping of the human papilloma virus E7 protein. Int Immunol. 1994 Feb;6(2):289-96.  
  20. Cuzick J et al Predicted impact of vaccination against human papillomavirus 16/18 on cancer incidence and cervical abnormalities in women aged 20-29 in the UK. Br J Cancer. 2010 Mar 2;102(5):933-9.  
  21. Howell-Jones R et al Multi-site study of HPV type-specific prevalence in women with cervical cancer, intraepithelial neoplasia and normal cytology, in England. Br J Cancer. 2010 Jul 13;103(2):209-16.  
  22. Paavonen J et al Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet. 2009 Jul 25;374(9686):301-14.
  23. Marlow LA et al Parental attitudes to pre-pubertal HPV vaccination. Vaccine. 2007 Mar 1;25(11):1945-52.
  24. Connors, T.A. et al. (1972) New platinum complexes with anti-tumour activity. Chem Biol Interact 5: 415-24