The Signs and symptoms of the early stages of cervical cancer may be completely asymptomatic. Vaginal bleeding, contact bleeding or a vaginal mass may indicate the presence of malignancy. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease, metastases may be present in the abdomen, lungs or elsewhere. Symptoms of advanced cervical cancer may include: loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, and single swollen leg, heavy bleeding from the vagina, leaking of urine from the vagina and bone fractures (Kumar et al. 2007).
Numerous studies of the epidemiology of cervical cancer have shown strong associations with religious, marital and sexual patterns. Although it is well established that women with multiple partners and early ages at first intercourse are at high risk, less is known about how these factors interact or how risk is affected by specific sexual characteristics.
Recent studies indicate that number of steady partners and frequent intercourse at early ages may further enhance risk, supporting hypotheses regarding a vulnerable period of the cervix and a need for repeated exposure to an infectious agent. It is now widely accepted that HPV is the major infectious etiological agent, but whether other infectious agents play supportive or interactive roles is unclear. Other speculative risk factors for cervical cancer include cigarette smoking, oral contraceptive usage and certain nutritional deficiencies, but again it is not clear whether these factors operate independently from HPV.
Although cervical cancer incidence trends correlate with the population prevalence of various venereally transmitted agents, it is not certain how disease rates are affected by other potential risk factors which have changed during recent time (e.g., exposure to HPV, sexual behavior, cigarette smoking). In addition, a number of recent studies highlight the need for considering not only female influences on risk of cervical cancer, but also male factors, since the sexual behavior of the male consort appear to play an important role.
A study has found a prevalence of 9% of cervical cancer cases among the general population in United States. The prevalence rates were 13.7% for non-Hispanic white women, 9.7% for Hispanic and 6.6% for Native American Women (Becker et al. 1991). Worldwide, cervical cancer is the second most common cancer in women after breast cancer and is the third leading killer behind breast and lung cancer. It affects about 16 per 100,000 women per year and causes death in about 9 per 100,000 per year. A recent survey conducted in the province of Ontario demonstrated that women aged 20 to 24 had the highest prevalence of HPV (24%).
In the United States, however, cervical cancer is only the 8th most common cancer of women. About 12,800 women in the United States are diagnosed with cervical cancer and about 4,800 die each year. Among gynecological cancers it ranks behind endometrial cancer and ovarian cancer. The incidence and mortality figure for the U.S. are about half that of the rest of the world, a difference which can be attributed in part to the success of screening with the Pap smear (Canavan & Doshi 2000).
A study published by Castellsague in 2002 reports that male circumcision can reduce the risk of penile human papillomavirus