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Cervical intraepithelial neoplasia (CIN) is the name given to abnormal changes in the cells of the outer surface of the cervix, called the ectocervix. These abnormalities are graded by how deep they are through the lining of the cervix. If the abnormal cells are only present in the lowest third of the lining covering the cervix, they are classified as CIN1 or low grade changes, if they are present in two-thirds of the lining they are classified as CIN2 or moderate changes, and if they are present throughout the full lining of the cervix they are called CIN3 or severe changes.
In recent years, research has shown that women who have a history of high grade cervical abnormalities (CIN2 and CIN3) or cervical cancer may have a higher chance or are at a ‘higher risk’ of going on to develop vaginal, vulval and anal cancers than the general population . Women with a history of CIN1 do not have this increased risk. This increased risk is thought to be linked to the fact that women who have had cervical abnormalities or cervical cancer may be more vulnerable to infections by high-risk human papillomavirus (HPV), which is linked to all of the above cancers .
The increases in the risks for vulval, anal, and vaginal cancer that have been shown in women with a history of high grade cervical abnormalities or cervical cancer are shown in the table below. These risks might sound high, but it is important to remember that the risks for these cancers in the general population are very small. All three are rare cancers, each accounting for less than 1% of the UK cancer cases each year . This mean the general population risk is very low for these cancers (see table below). This means that even with a risk seven times higher than the general public, women with a history of high grade cervical abnormalities or cervical cancer still have a very low risk of developing vaginal cancer.
|Type of cancer||General population risk||Increase in risk|
|Vulval||4/100,000 women in the UK affected ||Two times higher |
|Anal||2/100,000 women in the UK affected ||Four and a half times higer |
|Vaginal||0.7/100,000 women in the UK affected ||Seven times higher |
Smoking can significantly increase your risk of developing these cancers. Smoking affects the immune system of the cells in these areas and can make it harder to prevent and clear high-risk HPV infections. If you are a smoker it is therefore a great idea to try and quit in order to give your immune system the best chance of fighting off any high-risk HPV infections. For more information or support in helping you quit, visit the NHS Smokefree website.
Just like cervical cancer, each of these cancers also goes through a precancerous/abnormal stage. They are called:
However, since there are no screening programmes for anal, vaginal or vulval abnormalities or cancers, like there is for the cervix, it can be more difficult to diagnose them. This means that it is particularly important to be aware of any increased risk you may have and the symptoms associated with these cancers so that you can talk to your health care team if you have any concerns.
The main symptoms to look out for with vulval, anal and vaginal cancers are any unusual bleeding, discharge, pain or lumps. Full details on these symptoms can be found at the below links:
Remember, these symptoms can be associated with many other conditions that are not cancer related, but it is important to get them checked by a doctor.
Some research has also suggested that HPV vaccination could be beneficial for those who have a history of CIN or cervical cancer. But more research is needed on this and currently the HPV vaccination is not available to women with this history on the NHS.
Our support services are here for you if you need to talk, have questions or would like to connect with other women who understand what you are going through:
You may also find the following organisations useful: