Early-onset of sexual activity as a potential risk of cervical cancer in Africa: A review of literature

Abstract

Introduction In most African countries, cervical cancer is the most common cancer among women, both in terms of incidence and fatality. In the existing literature, age is risk factor for developing cervical cancer since it occurs mainly after the middle life of women. However, there have been contradictory findings in the literature on whether early sexual intercourse is linked to cervical cancer, with some studies indicating no relationship and others reporting an increased risk. Hence, this review analyzed data from recently published studies on cervical cancer. Methods Seven databases (MEDLINE via PubMed, Google Scholar, Scopus, Medscape, EMBASE, African Journals Online and Science Direct) were searched for papers published from January 2000 to March 2022 in English. Ten studies were included in analysis. The statistical analysis was performed using STATA 11. Heterogeneity between-study was explored by forest plot and inconsistency index (I2). The publication bias was checked by a funnel plot and Egger’s test. The pooled estimates of odds ratios were calculated by a random-effects model. Results In the subgroup analysis, there was no significant association between early sexual activity and cervical cancer. However, the overall pooled analysis of these ten studies revealed that there is an association between early sexual debut and cervical cancer. In the random effect model, we found a pooled odds ratio of 2.95 (95% CI = 1.06, 4.83), indicating that women who began sexual intercourse before the age of 18 had a higher risk of getting cervical cancer than adult women. Conclusion In this analysis, women who began having early sexual debut had a greater risk of developing cervical cancer than those who initiated sexual intercourse later in life. Delaying the age of first sexual activity among adolescents could help prevent the occurrence of cervical cancer.

Role of the epithelium in human papillomavirus and human immunodeficiency virus infections in the female genital tract

“…Consequently, a compromised mucosal barrier, and particularly the epithelium, increases the risk of acquiring these latter two viral infections. Recognised factors contributing to a broken or fragile epithelium include cervical ectopy (60), fluctuations in levels of reproductive hormones which may lead to a thin epithelium (38), high-risk sexual behaviour such as unprotected sex and early coitarche (61), co-presence of other sexually transmitted infections (62,63), altered microbiome (64,65) and inflammation in HIV-1 infection (66). In addition, there is an association between HPV and HIV-1, with the one worsening the other's pathogenesis (67,68).…”

“Easy women get it”: pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program

“…We have seen that misinterpretation and over-emphasis of less-significant risk factors related to sexual behavior stigmatizes women (regardless of whether they even have any of these risk factors). While early sexual initiation and number of sexual partners have been identified in epidemiological studies as increasing the likelihood of testing positive for HPV or developing cervical cancer [ 31 , 32 ], the importance of these risk factors for individual women and public health planning is minimal compared to improving access to HPV vaccination, screening, and treatment. An HPV infection can be acquired from any sexual partner, past or present, and does not imply infidelity or promiscuity.…”

“Easy women get it”: Pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program

“…We have seen that misinterpretation and over-emphasis of less-significant risk factors related to sexual behavior stigmatizes women (regardless of whether they even have any of these risk factors). While early sexual initiation and number of sexual partners have been identified in epidemiological studies as increasing the likelihood of testing positive for HPV or developing cervical cancer ( 29 , 30 ), the importance of these risk factors for individual women and public health planning is minimal compared to improving access to HPV vaccination, screening, and treatment. An HPV infection can be acquired from any sexual partner, past or present, and does not imply infidelity or promiscuity.…”