Risk factors for cancer of the cervix: Age 35-45 years. Pre-cancerous lesions occur 10-15 years earlier. Coitus before the age of 18 years. Multiple sexual paners. Delivery of the first baby before the age of 20 years. Multiparity with poor bih spacing between pregnancies. Poor personal hygiene. Carcinoma of the cervix shares similar epidemiological features to those of sexually transmitted diseases and viral infections and these are strongly linked to cancer cervix as causative agents. Poor socioeconomic status. At one time, exposure to smegma from uncircumcised paners was considered an impoant factor, accounting for lower incidence of cancer of the cervix amongst Jews and Muslims. Now it is realized that the incidence of human papilloma virus (HPV) is low in circumcised men, and that is the reason for low incidence of cancer in their wives. Smoking and drug abuse, including alcohol, are immunosuppressive (13-fold). Women with STD, HIV infection, herpes simplex virus 2 infection, HPV infection (16, 18, 31, 33) and condylomata have a high predisposition to cancer. Of these, HPV is now considered the most impoant oncogenic cause. Most HPV infection 16, 18 are symptomless in young women and clear within 2 years. Persistent infection is the cause of cancer of the cervix in 70-90% cases.Before the age of 30 years, 90% women with intact immune system are able to get rid of HPV infections. 10% with persistent infection after the age of 30 years tend to progress to CIN or invasive cancer. Immunosuppressed individuals (following transplant surgery), viral infections and HIV. Women with pre-invasive lesions. Use of oral contraceptive pills Ref: Shaw Gynecology 17e pg 408.