Predispose risk factor for carcinoma cervix is

Le. (All of the above): (399-400 - Shaw's 15th)PREDISPOISING RISK FACTORS IN CARCINOMA CERVIX* Average age 35-45 years. Precancerous lesions occur 10-15 years earlier* Coitus before the age of 18 years* Multiple sexual partners* Delivery of the first baby before the age of 20 years* Multiparity with poor birth spacing between pregnancies* Poor personal hygiene* Poor socioeconomic status* At one time, exposure to smegma from uncircumcised partners was considered on important factor accounting for lower incidence of cancer of the cervix amongst the Jews and Muslims. Now it is realized that the incidence of 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 immuno suppressive (13 fold)* Women with STD, HIV infection HSV-2 infection, HPV infection (16 18 31 33) or condylomata have a high predisposition to cancer, of these HPV is now considered the most important 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* Immuno suppressed individuals (following transplant surgery)* Women with pre invasive lesions* Woman who do not come for regular health check up and Pap tests* OCP and progestogens use over 8 year period can cause adenocarcinoma of the endocervix* 5% women exposed to diethyl stilboesterol in utero developed carcinoma of vagina and cervix with withdrawl of this hormone in incidence has dropped