What is the main association between the occurrence of cervical cancer? A lot of clinical, molecular and epidemiological data show that high-risk human papillomavirus (HPV) is the main cause of cervical cancer, and the current detection rate of HPV in cervical cancer tissues is 99%. It can be said with certainty that HPV infection is the basic factor in the occurrence of cervical cancer, and other factors such as premature sex, multiple births, multiple sexual partners, smoking, and oral contraceptives are all supporting or predisposing factors. HPV infects cervical basal cells or immature squamous cells through damaged squamous epithelium, and viral DNA can enter the cells with cell replication and latent in human body, which usually remains quiescent. When the immunity of the body is low and local trauma or infection occurs again, the viral gene will be integrated in the host cell genome, and the virus will make complete replication and play an activating role to produce damage to the host cell and promote the development of cancer. The presence or absence of HPV infection, or whether HPV can be cleared, is the key to the development of cervical cancer. HPV infection is very common among women, but most of them can remit spontaneously, while only a few develop persistent infection and can develop into cervical precancerous lesions and eventually progress to invasive cervical cancer. From HPV infection to cervical cancer formation, there is a rather long precancerous period. If timely diagnosis and correct treatment can be made at this stage, cervical cancer can be completely prevented or even cured. Cervical precancerous lesions, the standard name of which is cervical intraepithelial neoplasia (CIN), including cervical atypical hyperplasia and cervical carcinoma in situ, refers to the intermediate process of transformation from normal squamous epithelium to invasive carcinoma, which is divided into CINⅠ, CINⅡ and CINⅢ, reflecting the evolution of cervical carcinogenesis. about 10%-20% of cases will progress to invasive carcinoma in about 10 years after CIN formation, and the rest either The risk of CIN I, CIN II and CIN III developing into cancer is 15%, 30% and 45% respectively. Does chronic cervicitis always develop into cervical cancer? Chronic cervicitis is an inflammatory disease of the reproductive tract and a common disease among women. It is divided into cervical erosion, cervical polyps, cervical hypertrophy, cervical glandular cysts (nasal cysts), cervical mucositis, etc. According to the pathological types, these pathological types can exist alone or occur simultaneously in the same woman. Chronic inflammation is called cervical erosion. The common bacterial pathogens that cause chronic cervicitis are mainly Staphylococcus, Streptococcus, Escherichia coli and Enterococcus. These bacteria can enter the deep tissue of the cervix through small wounds in the cervix (such as after abortion or childbirth) and cause inflammation, which often manifests clinically as subacute episodes and develops into chronic inflammation if not treated promptly. In the past, it was thought that cervical erosion, polyps, tears and ectopia were the pre-cancerous lesions of the cervix. However, it is now clear that cervical cancer is caused by persistent infection with high-risk HPV, and chronic cervicitis and cervical cancer each have different pathogenic factors. In addition, from the perspective of pathological histological changes of the cervix, precancerous lesions refer to those with atypical hyperplasia found in the squamous epithelium of the cervical tissue, whereas various pathological types of chronic cervicitis are not atypical hyperplasia. Therefore, although chronic cervicitis can coexist with other cervical diseases, it is incorrect to say that it will definitely develop into cervical cancer, and cervical cancer does not necessarily develop from poorly treated cervicitis. Is cervical erosion a high risk factor for the development of cervical cancer? Chronic cervicitis and cervical cancer should be viewed separately, but the relationship between cervicitis and cervical cancer is very subtle. According to the cancer prevention survey, chronic cervicitis, especially cervical erosion, is a high-risk factor for cervical cancer. 0.39% of people without cervical erosion have cervical cancer, while 2.05% of people with cervical erosion have cervical cancer. Cervical erosion is not the real cervical erosion, but only a single layer of columnar epithelium in the lining of the cervical canal, replacing the original squamous epithelial cells outside the cervix, because the columnar epithelium is thin and the interstitium under it is permeable and red, so many scholars advocate that “cervical erosion” should be called “cervical columnar epithelial ectopic” instead. The cervical epithelial ectoplasia is a common problem in the cervical area. As the resistance of cervical columnar epithelium is low, pathogens can easily invade and inflammation occurs. How to prevent the occurrence of cervical cancer? The occurrence of cervical cancer requires a slow process of cervical lesions developing to cervical cancer, providing conditions for prevention, early detection and treatment. Compared with other tumors, the cervical area is connected to the outside world and cervical lesions can be diagnosed through direct observation or sampling of lesions, making cervical cancer a tumor that can be diagnosed and treated at an early stage. -Histological examination. As the etiology of cervical cancer has been studied, high-risk HPV-DNA testing has been introduced for cervical cancer screening. Its test has a very high negative predictive value, which can effectively reduce the rate of missed diagnosis of cervical cancer and highly pathological lesions. Women with negative HPV-DNA and negative cytology can be screened at longer intervals. Should people with smooth cervix be screened for cervical cancer? Because most patients with cervical cancer and precancerous lesions often have varying degrees of cervical erosion combined with visual observation, clinicians tend to attach great importance to cervical erosion and ignore those with smooth cervix. In one study, liquid-based cytology examination of 1,898 cases with smooth cervix revealed different degrees of epithelial cell abnormalities accounting for 15.12% of the cases, and further colposcopic biopsy of these cases revealed that CIN I accounted for 21.38%, CIN II accounted for 11.29%, CIN III accounted for 5.80%, and cervical cancer accounted for 3.26%, all of which were endogenous. Therefore, patients with cervical cancer may also present with a smooth cervix and do not always have the manifestation of cervical erosion. For women with a history of sexual intercourse, cervical cancer screening should be routinely performed even if the cervix is smooth. Does chronic cervicitis have to be treated? Treating chronic cervicitis patients with combined high-risk HPV infection to remove the latent state of the virus and interrupt the persistent HPV infection has positive significance in preventing cervical cancer. However, there are clinical cases of over-treatment. Physiotherapy can give a “smooth” appearance to the cervix, but can cause the transformation zone (or migrating zone) of the cervix to move inward. The transformation zone is the main site of cervical cancer and the main location for colposcopic observation. When precancerous lesions or cervical cancer appear in the transformation zone that has moved into the cervical canal, it is difficult to examine and often results in missed diagnosis. Therefore, unnecessary physical therapy can, on the contrary, affect the results of subsequent screening and make diagnosis more difficult. Most HPV infections are transient and will be eliminated by the body’s immune response even without treatment. More than 90% of HPV-positive patients will automatically turn negative within 4-6 months and do not need much intervention. Therefore, different treatment methods should be chosen according to the specific situation of each patient.